{"hospital_name":"SPALDING @ PSL","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":["SPALDING @ PSL"],"hospital_address":["1719 East 19th Avenue, Denver, CO, 80218"],"license_information":{"hospital_license_number":"10433","state":"CO"},"standard_charge_information":[{"description":"Walker, rigid, wheeled, adjustable or fixed height ","code_information":[{"code":"E0141","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":53.26,"maximum":57.07,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":57.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":53.26,"methodology":"fee schedule"}]}]},{"description":"Wheelchair, pediatric size, rigid, adjustable, with seating system ","code_information":[{"code":"E1235","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":248.38,"maximum":266.12,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":253.45,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":253.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":253.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":253.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":253.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":253.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":253.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":253.45,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":253.45,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":266.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":253.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":250.92,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":258.52,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":253.45,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":253.45,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":253.45,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":253.45,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":253.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":248.38,"methodology":"fee schedule"}]}]},{"description":"Addition to cervical-thoracic-lumbar-sacral orthosis (ctlso) or scoliosis orthosis, axilla sling ","code_information":[{"code":"L1010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":72.36,"maximum":77.53,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":77.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":73.10,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":75.32,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":73.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":72.36,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, below knee, thigh lacer, nonmolded ","code_information":[{"code":"L5680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":426.84,"maximum":457.33,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":435.55,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":435.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":435.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":435.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":435.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":435.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":435.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":435.55,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":435.55,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":457.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":435.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":431.19,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":444.26,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":435.55,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":435.55,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":435.55,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":435.55,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":435.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":426.84,"methodology":"fee schedule"}]}]},{"description":"Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock ","code_information":[{"code":"L5814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4337.85,"maximum":4647.70,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4426.38,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4426.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4426.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4426.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4426.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4426.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4426.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4426.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4426.38,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4647.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4426.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4382.12,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4514.91,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4426.38,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4426.38,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4426.38,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4426.38,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4426.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4337.85,"methodology":"fee schedule"}]}]},{"description":"All lower extremity prostheses, energy storing foot (seattle carbon copy ii or equal) ","code_information":[{"code":"L5976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":694.56,"maximum":744.17,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":708.73,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":708.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":708.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":708.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":708.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":708.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":708.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":708.73,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":708.73,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":744.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":708.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":701.64,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":722.90,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":708.73,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":708.73,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":708.73,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":708.73,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":708.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":694.56,"methodology":"fee schedule"}]}]},{"description":"Antibody; Aspergillus ","code_information":[{"code":"86606","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.40,"maximum":15.80,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":15.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":15.35,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":11.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":15.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14.75,"methodology":"fee schedule"}]}]},{"description":"Antibody; Toxoplasma ","code_information":[{"code":"86777","type":"CPT"},{"code":"903064","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":14.10,"maximum":37.62,"gross_charge":363.85,"discounted_cash":363.85,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":15.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":14.68,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":37.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":37.62,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":36.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":14.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14.10,"methodology":"fee schedule"}]}]},{"description":"Battery charger, six volt, each ","code_information":[{"code":"L7362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":383.73,"maximum":411.14,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":391.56,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":391.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":391.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":391.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":391.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":391.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":391.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":391.56,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":391.56,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":411.14,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":391.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":387.64,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":399.39,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":391.56,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":391.56,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":391.56,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":391.56,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":391.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":383.73,"methodology":"fee schedule"}]}]},{"description":"Blood typing, serologic; RBC antigens, other than ABO or Rh (D), each ","code_information":[{"code":"86905","type":"CPT"},{"code":"947180","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":3.75,"maximum":193.05,"gross_charge":134.24,"discounted_cash":134.24,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3.75,"methodology":"fee schedule"}]}]},{"description":"Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), fiberglass ","code_information":[{"code":"Q4016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15.87,"maximum":17.00,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.03,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16.51,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15.87,"methodology":"fee schedule"}]}]},{"description":"Chemotaxis assay, specify method ","code_information":[{"code":"86155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.67,"maximum":72.27,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":16.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":15.83,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16.31,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":72.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":72.27,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":69.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":15.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15.67,"methodology":"fee schedule"}]}]},{"description":"Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment ","code_information":[{"code":"L1690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2254.22,"maximum":2415.23,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2300.22,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2300.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2300.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2300.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2300.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2300.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2300.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2300.22,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2300.22,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2415.23,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2300.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2277.22,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2346.22,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2300.22,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2300.22,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2300.22,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2300.22,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2300.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2254.22,"methodology":"fee schedule"}]}]},{"description":"Crutch, underarm, articulating, spring assisted, each ","code_information":[{"code":"E0117","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":25.75,"maximum":27.59,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":27.59,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":26.02,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":26.81,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":26.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":25.75,"methodology":"fee schedule"}]}]},{"description":"DPYD (dihydropyrimidine dehydrogenase) (eg, 5-fluorouracil/5-FU and capecitabine drug metabolism), gene analysis, common variant(s) (eg, *2A, *4, *5, *6) ","code_information":[{"code":"81232","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":171.31,"maximum":2574.99,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":183.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":173.06,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":178.31,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2574.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2574.99,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2470.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":171.31,"methodology":"fee schedule"}]}]},{"description":"Electric hook, switch or myoelectric controlled, pediatric ","code_information":[{"code":"L7045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1856.63,"maximum":1989.25,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1894.52,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1894.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1894.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1894.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1894.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1894.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1894.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1894.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1894.52,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1989.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1894.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1875.57,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1932.41,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1894.52,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1894.52,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1894.52,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1894.52,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1894.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1856.63,"methodology":"fee schedule"}]}]},{"description":"Fetal congenital abnormalities, biochemical assays of two proteins (PAPP-A, hCG ºany form»), utilizing maternal serum, algorithm reported as a risk score ","code_information":[{"code":"81508","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":53.21,"maximum":2566.08,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":54.30,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":54.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":54.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":54.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":54.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":54.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":54.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":54.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":54.30,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":57.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":54.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":53.76,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":55.39,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":54.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2566.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2566.08,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":54.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2462.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":54.30,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":54.30,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":54.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":53.21,"methodology":"fee schedule"}]}]},{"description":"Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing ","code_information":[{"code":"A6209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10.00,"maximum":10.71,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":10.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":10.10,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":10.40,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":10.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10.00,"methodology":"fee schedule"}]}]},{"description":"Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, IgG1, 2, 3, or 4), each ","code_information":[{"code":"82787","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.86,"maximum":32.67,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":8.42,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7.94,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":8.18,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":32.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":32.67,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":31.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":8.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7.86,"methodology":"fee schedule"}]}]},{"description":"Gradient compression garment, neck/head, each ","code_information":[{"code":"A6566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":236.01,"maximum":252.87,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":252.87,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":238.42,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":245.65,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":240.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":236.01,"methodology":"fee schedule"}]}]},{"description":"Halo procedure, cervical halo incorporated into milwaukee type orthosis ","code_information":[{"code":"L0830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3380.94,"maximum":3622.44,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3449.94,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3449.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3449.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3449.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3449.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3449.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3449.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3449.94,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3449.94,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3622.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3449.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3415.44,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3518.94,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3449.94,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3449.94,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3449.94,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3449.94,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3449.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3380.94,"methodology":"fee schedule"}]}]},{"description":"Heinz bodies; induced, acetyl phenylhydrazine ","code_information":[{"code":"85445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.68,"maximum":48.51,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":7.16,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":6.75,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":6.96,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":46.55,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":6.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":6.68,"methodology":"fee schedule"}]}]},{"description":"Hereditary colon cancer-related disorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis), genomic sequence analysis panel, 5 or more genes, interrogati ","code_information":[{"code":"81435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":573.20,"maximum":1943.37,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":614.14,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":579.05,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":596.60,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1943.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1943.37,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1864.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":573.20,"methodology":"fee schedule"}]}]},{"description":"HLA typing; lymphocyte culture, mixed (MLC) ","code_information":[{"code":"86821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35.83,"maximum":73.26,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":38.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":36.19,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":37.29,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":73.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":73.26,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":70.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":36.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":35.83,"methodology":"fee schedule"}]}]},{"description":"Human Platelet Antigen 9 genotyping (HPA-9w), ITGA2B (integrin, alpha 2b ºplatelet glycoprotein IIb of IIb/IIIa complex, antigen CD41» ºGPIIb») (eg, neonatal alloimmune thrombocytopenia ºNAIT», post-t ","code_information":[{"code":"81111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119.78,"maximum":349.47,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":128.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":121.00,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":349.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":349.47,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":335.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":119.78,"methodology":"fee schedule"}]}]},{"description":"Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment, suspension, and one cast change, below knee ","code_information":[{"code":"L5400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1409.69,"maximum":1510.38,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1438.46,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1438.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1438.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1438.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1438.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1438.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1438.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1438.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1438.46,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1510.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1438.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1424.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1467.23,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1438.46,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1438.46,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1438.46,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1438.46,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1438.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1409.69,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay ºEIA», enzyme-linked immunosorbent assay ºELISA», fluorescence immunoassay ºFIA», immunochemiluminometric assay ºIMC ","code_information":[{"code":"87350","type":"CPT"},{"code":"902979","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.30,"maximum":40.59,"gross_charge":19.20,"discounted_cash":19.20,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":38.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.30,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcript ","code_information":[{"code":"87505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":95.95,"maximum":134.70,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":134.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":127.01,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":130.86,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":95.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":128.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":125.72,"methodology":"fee schedule"}]}]},{"description":"Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, reverse transcriptase and protease regions ","code_information":[{"code":"87901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66.50,"maximum":270.32,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":270.32,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":254.88,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":262.60,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":69.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":69.30,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":66.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":257.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":252.30,"methodology":"fee schedule"}]}]},{"description":"Interface for cough stimulating device, includes all components, replacement only ","code_information":[{"code":"A7020","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":19.36,"maximum":20.74,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":20.74,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":19.55,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":20.14,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":19.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19.36,"methodology":"fee schedule"}]}]},{"description":"Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf ","code_information":[{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":59.64,"maximum":63.90,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":63.90,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":60.25,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":62.08,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":60.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":59.64,"methodology":"fee schedule"}]}]},{"description":"Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) ","code_information":[{"code":"83718","type":"CPT"},{"code":"902545","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":8.03,"maximum":131.67,"gross_charge":190.91,"discounted_cash":190.91,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":8.11,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":8.35,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":131.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":131.67,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":126.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":8.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":8.03,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, foam filled propulsion tire, any size, each ","code_information":[{"code":"E2216","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":51.31,"maximum":54.98,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":54.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":51.84,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":53.41,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":52.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":51.31,"methodology":"fee schedule"}]}]},{"description":"Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity ","code_information":[{"code":"83861","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22.03,"maximum":68.31,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":23.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22.26,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":22.93,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":68.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":68.31,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":65.55,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22.03,"methodology":"fee schedule"}]}]},{"description":"Mucin, synovial fluid (Ropes test) ","code_information":[{"code":"83872","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.74,"maximum":47.52,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":6.15,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.80,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.98,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":47.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":47.52,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":45.60,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.74,"methodology":"fee schedule"}]}]},{"description":"Non-invasive vagus nerve stimulator ","code_information":[{"code":"E0735","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":48.76,"maximum":52.24,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":52.24,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":49.25,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":50.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":49.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":48.76,"methodology":"fee schedule"}]}]},{"description":"Oncology (ovarian), biochemical assays of two proteins (CA-125 and HE4), utilizing serum, with menopausal status, algorithm reported as a risk score ","code_information":[{"code":"81500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":255.29,"maximum":2614.59,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":273.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":257.89,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":265.71,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2614.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2614.59,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2508.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":260.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":255.29,"methodology":"fee schedule"}]}]},{"description":"Orthopedic shoe addition, toe tap standard ","code_information":[{"code":"L3550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10.41,"maximum":11.15,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":10.83,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":10.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10.41,"methodology":"fee schedule"}]}]},{"description":"Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each ","code_information":[{"code":"A5056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6.25,"maximum":6.70,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":6.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":6.32,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":6.51,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":6.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":6.25,"methodology":"fee schedule"}]}]},{"description":"Pacemaker monitor, self contained, checks battery depletion and other pacemaker components, includes digital/visible check systems ","code_information":[{"code":"E0615","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":640.21,"maximum":685.94,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":653.28,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":653.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":653.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":653.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":653.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":653.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":653.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":653.28,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":653.28,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":685.94,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":653.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":646.75,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":666.35,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":653.28,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":653.28,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":653.28,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":653.28,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":653.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":640.21,"methodology":"fee schedule"}]}]},{"description":"Portable oxygen contents, liquid, 1 month's supply = 1 unit ","code_information":[{"code":"E0444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":59.17,"maximum":63.40,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":63.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":59.78,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":61.59,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":60.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":59.17,"methodology":"fee schedule"}]}]},{"description":"Addition to knee joint, lift loop for drop lock ring ","code_information":[{"code":"L2492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":137.67,"maximum":147.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":147.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":139.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":143.29,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":140.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":137.67,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with hydraulic swing phase control ","code_information":[{"code":"L5613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3529.08,"maximum":3781.16,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3601.10,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3601.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3601.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3601.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3601.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3601.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3601.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3601.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3601.10,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3781.16,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3601.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3565.09,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3673.12,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3601.10,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3601.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3601.10,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3601.10,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3601.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3529.08,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, symes type, expandable wall socket ","code_information":[{"code":"L5630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":562.99,"maximum":603.20,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":574.48,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":574.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":574.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":574.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":574.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":574.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":574.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":574.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":574.48,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":603.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":574.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":568.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":585.97,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":574.48,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":574.48,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":574.48,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":574.48,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":574.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":562.99,"methodology":"fee schedule"}]}]},{"description":"Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment ","code_information":[{"code":"L6890","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":208.76,"maximum":223.67,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":213.02,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":213.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":213.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":213.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":213.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":213.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":213.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":213.02,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":213.02,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":223.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":213.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":210.89,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":217.28,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":213.02,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":213.02,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":213.02,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":213.02,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":213.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":208.76,"methodology":"fee schedule"}]}]},{"description":"Adjustable angle footplate, each ","code_information":[{"code":"K0040","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":60.32,"maximum":64.63,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":61.55,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":61.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":61.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":61.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":61.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":61.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":61.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":61.55,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":61.55,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":64.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":61.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":60.93,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":62.78,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":61.55,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":61.55,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":61.55,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":61.55,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":61.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":60.32,"methodology":"fee schedule"}]}]},{"description":"Amino acids; single, qualitative, each specimen ","code_information":[{"code":"82127","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.90,"maximum":48.51,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14.04,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":46.55,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":13.90,"methodology":"fee schedule"}]}]},{"description":"Antibody screen, RBC, each serum technique ","code_information":[{"code":"86850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.57,"maximum":925.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":10.26,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9.67,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":9.97,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":925.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":925.65,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":888.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":9.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9.57,"methodology":"fee schedule"}]}]},{"description":"Antihuman globulin test (Coombs test); direct, each antiserum ","code_information":[{"code":"86880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.28,"maximum":923.67,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.66,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.50,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":923.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":923.67,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":886.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.28,"methodology":"fee schedule"}]}]},{"description":"b-Hexosaminidase, each assay ","code_information":[{"code":"83080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.53,"maximum":25.74,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.70,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":25.74,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":24.70,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16.53,"methodology":"fee schedule"}]}]},{"description":"Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type ","code_information":[{"code":"L8000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":43.22,"maximum":46.31,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":46.31,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":43.66,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":44.98,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":44.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":43.22,"methodology":"fee schedule"}]}]},{"description":"Cast supplies, long arm cast, pediatric (0-10 years), plaster ","code_information":[{"code":"Q4007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7.74,"maximum":8.29,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":8.29,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7.82,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":8.06,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":7.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7.74,"methodology":"fee schedule"}]}]},{"description":"Chorionic gonadotropin stimulation panel; estradiol response This panel must include the following: Estradiol, total (82670 x 2 on 3 pooled blood samples) ","code_information":[{"code":"80415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54.77,"maximum":358.38,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":58.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":55.33,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":57.01,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":358.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":358.38,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":343.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":55.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":54.77,"methodology":"fee schedule"}]}]},{"description":"Column chromatography, includes mass spectrometry, if performed (eg, HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, ","code_information":[{"code":"82542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":23.61,"maximum":64.35,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25.29,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":23.85,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":24.57,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":64.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":64.35,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":61.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":24.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":23.61,"methodology":"fee schedule"}]}]},{"description":"Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated ","code_information":[{"code":"L0112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1631.57,"maximum":1748.11,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1664.87,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1664.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1664.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1664.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1664.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1664.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1664.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1664.87,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1664.87,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1748.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1664.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1648.22,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1698.17,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1664.87,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1664.87,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1664.87,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1664.87,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1664.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1631.57,"methodology":"fee schedule"}]}]},{"description":"Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or nail ","code_information":[{"code":"87101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.56,"maximum":18.81,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":8.10,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7.63,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":18.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":18.81,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7.56,"methodology":"fee schedule"}]}]},{"description":"Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities; interrogation of genomic regions for copy number and single nucleotide polymorphism (SNP) variants, comparative genomic ","code_information":[{"code":"81229","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":799.90,"maximum":1218.00,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1218.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1148.40,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1183.20,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":833.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":833.58,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":799.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1160.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1136.80,"methodology":"fee schedule"}]}]},{"description":"Drug assay, definitive, 120 or more drugs and metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS), includes specimen validity and algorithmic analysis descr ","code_information":[{"code":"0328U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112.14,"maximum":120.15,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":120.15,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":113.29,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":112.14,"methodology":"fee schedule"}]}]},{"description":"Estradiol; free, direct measurement (eg, equilibrium dialysis) ","code_information":[{"code":"82681","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27.38,"maximum":92.07,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":29.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":27.66,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":28.50,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":92.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":92.07,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":88.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":27.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":27.38,"methodology":"fee schedule"}]}]},{"description":"Fetal lung maturity assessment; lecithin sphingomyelin (L/S) ratio ","code_information":[{"code":"83661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21.55,"maximum":55.44,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":23.09,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":21.77,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":22.43,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":53.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":21.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":21.55,"methodology":"fee schedule"}]}]},{"description":"Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each ","code_information":[{"code":"L3020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":231.27,"maximum":247.79,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":235.99,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":235.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":235.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":235.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":235.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":235.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":235.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":235.99,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":235.99,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":247.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":235.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":233.63,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":240.71,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":235.99,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":235.99,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":235.99,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":235.99,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":235.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":231.27,"methodology":"fee schedule"}]}]},{"description":"Galactose-1-phosphate uridyl transferase; quantitative ","code_information":[{"code":"82775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20.65,"maximum":50.49,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":22.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":20.86,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":21.49,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":50.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":50.49,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":48.45,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":21.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":20.65,"methodology":"fee schedule"}]}]},{"description":"Glutamyltransferase, gamma (GGT) ","code_information":[{"code":"82977","type":"CPT"},{"code":"902452","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":7.06,"maximum":16.83,"gross_charge":146.15,"discounted_cash":146.15,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":7.20,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":7.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":7.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":7.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":7.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":7.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":7.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":7.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":7.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":7.56,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":7.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7.13,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":7.34,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":7.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":7.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":7.20,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":7.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":7.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7.06,"methodology":"fee schedule"}]}]},{"description":"Growth hormone suppression panel (glucose administration) This panel must include the following: Glucose (82947 x 3) Human growth hormone (HGH) (83003 x 4) ","code_information":[{"code":"80430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126.35,"maximum":135.80,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":135.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":128.04,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":131.92,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":131.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":131.67,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":126.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":129.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":126.74,"methodology":"fee schedule"}]}]},{"description":"Heat lamp, without stand (table model), includes bulb, or infrared element ","code_information":[{"code":"E0200","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":106.01,"maximum":113.58,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":108.17,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":108.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":108.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":108.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":108.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":108.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":108.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":108.17,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":108.17,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":113.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":108.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":110.33,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":108.17,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":108.17,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":108.17,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":108.17,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":108.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":106.01,"methodology":"fee schedule"}]}]},{"description":"High strength lightweight wheelchair, fixed full length arms, swing away detachable elevating leg rests ","code_information":[{"code":"E1087","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":147.02,"maximum":157.52,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":157.52,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":148.52,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":153.02,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":150.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":147.02,"methodology":"fee schedule"}]}]},{"description":"Hospital bed, total electric (head, foot and height adjustments), with any type side rails, with mattress ","code_information":[{"code":"E0265","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":170.47,"maximum":182.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":173.95,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":173.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":173.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":173.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":173.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":173.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":173.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":173.95,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":173.95,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":182.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":173.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":172.21,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":177.43,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":173.95,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":173.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":173.95,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":173.95,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":173.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":170.47,"methodology":"fee schedule"}]}]},{"description":"Humidifier, non-heated, used with positive airway pressure device ","code_information":[{"code":"E0561","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":78.36,"maximum":83.96,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":83.96,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":79.16,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":81.56,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":79.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":78.36,"methodology":"fee schedule"}]}]},{"description":"Immunoelectrophoresis; crossed (2-dimensional assay) ","code_information":[{"code":"86327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29.32,"maximum":42.57,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":31.42,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":29.62,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":30.52,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":29.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":29.32,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunofluorescent technique; not otherwise specified, each organism ","code_information":[{"code":"87299","type":"CPT"},{"code":"949586","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":15.78,"maximum":33.66,"gross_charge":282.45,"discounted_cash":282.45,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":15.94,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16.42,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":32.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15.78,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, amplified probe technique, includes reverse transcription when performed ","code_information":[{"code":"87538","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34.39,"maximum":62.37,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":59.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":34.39,"methodology":"fee schedule"}]}]},{"description":"Infectious disease (bacterial or viral RTI) pathogen-specific DNA & RN A,21 targets,incl severe acute respiratory syndrome coronavirus 2(SARS- CoV-2), amplified probe technique,including multiple ","code_information":[{"code":"0225U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":408.44,"maximum":1191.96,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":437.62,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":412.61,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":425.12,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1191.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1191.96,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1143.80,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":416.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":408.44,"methodology":"fee schedule"}]}]},{"description":"Knee ankle foot orthosis, full plastic, single upright, with or without free motion knee, medial lateral rotation control, with or without free motion ankle, custom fabricated ","code_information":[{"code":"L2034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2426.20,"maximum":2599.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2475.71,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2475.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2475.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2475.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2475.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2475.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2475.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2475.71,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2475.71,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2599.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2475.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2450.95,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2525.22,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2475.71,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2475.71,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2475.71,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2475.71,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2475.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2426.20,"methodology":"fee schedule"}]}]},{"description":"Lactose, urine, qualitative ","code_information":[{"code":"83633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.03,"maximum":35.64,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":11.81,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.14,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":34.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":11.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.03,"methodology":"fee schedule"}]}]},{"description":"Front caster assembly, complete, with pneumatic tire, replacement only, each ","code_information":[{"code":"K0071","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":119.65,"maximum":128.19,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":122.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":122.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":122.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":122.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":122.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":122.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":122.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":122.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":122.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":128.19,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":122.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":120.87,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":124.53,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":122.09,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":122.09,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":122.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":122.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":122.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":119.65,"methodology":"fee schedule"}]}]},{"description":"Glucose; blood, reagent strip ","code_information":[{"code":"82948","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.94,"maximum":40.59,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.29,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.14,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":38.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.94,"methodology":"fee schedule"}]}]},{"description":"Gradient compression bandage roll, inelastic short stretch, per linear yard, any width, each ","code_information":[{"code":"A6599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1.58,"maximum":1.69,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1.59,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1.64,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1.58,"methodology":"fee schedule"}]}]},{"description":"Gradient compression wrap with adjustable straps, below knee, 30-50 mmhg, each ","code_information":[{"code":"A6583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":148.35,"maximum":158.95,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":158.95,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":149.87,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":154.41,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":148.35,"methodology":"fee schedule"}]}]},{"description":"Hemi-wheelchair, detachable arms desk or full length arms, swing away detachable elevating leg rests ","code_information":[{"code":"E1084","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":131.17,"maximum":140.54,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":140.54,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":132.51,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":136.53,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":133.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":131.17,"methodology":"fee schedule"}]}]},{"description":"Hepatitis A antibody (HAAb), IgM antibody ","code_information":[{"code":"86709","type":"CPT"},{"code":"902974","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.03,"maximum":33.66,"gross_charge":220.72,"discounted_cash":220.72,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":11.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.15,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":32.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":11.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.03,"methodology":"fee schedule"}]}]},{"description":"Hip orthosis, abduction control of hip joints, flexible, (pavlik harness), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an in ","code_information":[{"code":"L1620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":144.45,"maximum":154.77,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":147.40,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":147.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":147.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":147.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":147.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":147.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":147.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":147.40,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":147.40,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":154.77,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":147.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":145.93,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":150.35,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":147.40,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":147.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":147.40,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":147.40,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":147.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":144.45,"methodology":"fee schedule"}]}]},{"description":"Human Platelet Antigen 6 genotyping (HPA-6w), ITGB3 (integrin, beta 3 ºplatelet glycoprotein IIIa, antigen CD61» ºGPIIIa») (eg, neonatal alloimmune thrombocytopenia ºNAIT», post-transfusion purpura), ","code_information":[{"code":"81110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":119.78,"maximum":349.47,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":128.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":121.00,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":349.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":349.47,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":335.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":119.78,"methodology":"fee schedule"}]}]},{"description":"Indwelling catheter; specialty type, (e.g., coude, mushroom, wing, etc.), each ","code_information":[{"code":"A4340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":42.45,"maximum":45.49,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":45.49,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":42.89,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":44.19,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":43.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":42.45,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, amplified probe technique ","code_information":[{"code":"87486","type":"CPT"},{"code":"936527","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":34.39,"maximum":99.99,"gross_charge":335.48,"discounted_cash":335.48,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":95.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":34.39,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, quantification ","code_information":[{"code":"87542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40.92,"maximum":99.99,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":41.34,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":42.60,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":95.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":40.92,"methodology":"fee schedule"}]}]},{"description":"Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies ","code_information":[{"code":"L8603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":502.99,"maximum":538.92,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":513.26,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":513.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":513.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":513.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":513.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":513.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":513.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":513.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":513.26,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":538.92,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":513.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":508.13,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":523.53,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":513.26,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":513.26,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":513.26,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":513.26,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":513.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":502.99,"methodology":"fee schedule"}]}]},{"description":"Knee ankle foot orthosis, full plastic, with or without free motion knee, multi-axis ankle, custom fabricated ","code_information":[{"code":"L2038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1541.51,"maximum":1651.62,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1572.97,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1572.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1572.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1572.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1572.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1572.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1572.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1572.97,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1572.97,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1651.62,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1572.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1557.24,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1604.43,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1572.97,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1572.97,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1572.97,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1572.97,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1572.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1541.51,"methodology":"fee schedule"}]}]},{"description":"Lift, elevation, inside shoe, tapered, up to one-half inch ","code_information":[{"code":"L3332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":86.00,"maximum":92.14,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":87.75,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":87.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":87.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":87.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":87.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":87.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":87.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":87.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":87.75,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":92.14,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":87.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":86.87,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":89.50,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":87.75,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":87.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":87.75,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":87.75,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":87.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":86.00,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, tube for pneumatic caster tire, any size, each ","code_information":[{"code":"E2215","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":11.56,"maximum":12.39,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.68,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.56,"methodology":"fee schedule"}]}]},{"description":"Molecular cytogenetics; DNA probe, each (eg, FISH) ","code_information":[{"code":"88271","type":"CPT"},{"code":"948279","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":20.99,"maximum":429.66,"gross_charge":1413.85,"discounted_cash":1413.85,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":22.49,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":21.21,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":429.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":429.66,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":412.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":20.99,"methodology":"fee schedule"}]}]},{"description":"Nfct Agent HIV Trgt Viral Next-Gnrj Seq Alys Alg ","code_information":[{"code":"0219U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":710.50,"maximum":2074.05,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":725.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":725.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":725.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":725.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":725.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":725.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":725.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":725.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":725.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":761.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":725.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":717.75,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":739.50,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":725.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2074.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2074.05,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":725.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1990.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":725.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":725.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":725.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":710.50,"methodology":"fee schedule"}]}]},{"description":"Oncology (breast), mRNA, gene expression profiling by next-generation sequencing of 101 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a triple negative breast cancer ","code_information":[{"code":"0153U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3096.23,"maximum":9038.70,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3317.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3127.83,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3222.61,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":9038.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":9038.70,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8673.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3159.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3096.23,"methodology":"fee schedule"}]}]},{"description":"Oncology (urothelial), mRNA, gene expression profiling by real-time quantitative PCR of five genes (MDK, HOXA13, CDC2 ºCDK1», IGFBP5, and CXCR2), utilizing urine, algorithm reported as a risk score fo ","code_information":[{"code":"0013M","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":744.80,"maximum":2174.04,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":752.40,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2174.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2174.04,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2086.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":744.80,"methodology":"fee schedule"}]}]},{"description":"Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each ","code_information":[{"code":"A4423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2.48,"maximum":2.66,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2.50,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2.48,"methodology":"fee schedule"}]}]},{"description":"Partial hand, little and/or ring finger remaining ","code_information":[{"code":"L6010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1808.25,"maximum":1937.41,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1845.15,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1845.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1845.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1845.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1845.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1845.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1845.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1845.15,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1845.15,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1937.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1845.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1826.70,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1882.05,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1845.15,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1845.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1845.15,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1845.15,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1845.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1808.25,"methodology":"fee schedule"}]}]},{"description":"PMP22 (peripheral myelin protein 22) (eg, Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies) gene analysis; full sequence analysis ","code_information":[{"code":"81325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":754.19,"maximum":1716.66,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":808.06,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":761.88,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":784.97,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1716.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1716.66,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1647.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":769.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":754.19,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, group 24 non-sealed lead acid battery, each ","code_information":[{"code":"E2362","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":123.00,"maximum":131.79,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":125.51,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":125.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":125.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":125.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":125.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":125.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":125.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":125.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":125.51,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":131.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":125.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":124.25,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":128.02,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":125.51,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":125.51,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":125.51,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":125.51,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":125.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":123.00,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair, group 1 standard, sling/solid seat and back, patient weight capacity up to and including 300 pounds ","code_information":[{"code":"K0815","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":327.73,"maximum":351.14,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":334.42,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":334.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":334.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":334.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":334.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":334.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":334.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":334.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":334.42,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":351.14,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":334.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":331.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":341.11,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":334.42,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":334.42,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":334.42,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":334.42,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":334.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":327.73,"methodology":"fee schedule"}]}]},{"description":"Protein analysis of tissue by Western Blot, with interpretation and report; ","code_information":[{"code":"88371","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21.79,"maximum":255.42,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":23.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22.01,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":22.67,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":245.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":21.79,"methodology":"fee schedule"}]}]},{"description":"Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver ","code_information":[{"code":"L8683","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6208.23,"maximum":6651.68,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":6334.93,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":6334.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":6334.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":6334.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":6334.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":6334.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":6334.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":6334.93,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":6334.93,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":6651.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":6334.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":6271.58,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":6461.63,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":6334.93,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":6334.93,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":6334.93,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":6334.93,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":6334.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":6208.23,"methodology":"fee schedule"}]}]},{"description":"Red cell antigen (Lutheran blood group) genotyping (LU), gene analysis, BCAM (basal cell adhesion molecule) exon 3 ","code_information":[{"code":"0196U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":181.50,"maximum":529.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":194.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":183.35,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":529.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":529.65,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":508.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":181.50,"methodology":"fee schedule"}]}]},{"description":"Replacement, socket, above knee/knee disarticulation, including attachment plate, molded to patient model ","code_information":[{"code":"L5701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4350.48,"maximum":4661.23,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4439.27,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4439.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4439.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4439.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4439.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4439.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4439.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4439.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4439.27,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4661.23,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4439.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4394.88,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4528.06,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4439.27,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4439.27,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4439.27,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4439.27,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4439.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4350.48,"methodology":"fee schedule"}]}]},{"description":"Shoulder elbow wrist hand finger orthosis, abduction positioning (airplane design), thoracic component and support bar, includes one or more nontorsion joints, elastic bands, turnbuckles, may include ","code_information":[{"code":"L3978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2104.51,"maximum":2254.83,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2147.46,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2147.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2147.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2147.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2147.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2147.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2147.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2147.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2147.46,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2254.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2147.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2125.99,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2190.41,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2147.46,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2147.46,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2147.46,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2147.46,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2147.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2104.51,"methodology":"fee schedule"}]}]},{"description":"Sphere, single vision, plano to plus or minus 4.00, per lens ","code_information":[{"code":"V2100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":60.00,"maximum":64.28,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":61.22,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":61.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":61.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":61.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":61.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":61.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":61.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":61.22,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":61.22,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":64.28,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":61.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":60.61,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":62.44,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":61.22,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":61.22,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":61.22,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":61.22,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":61.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":60.00,"methodology":"fee schedule"}]}]},{"description":"Sugars (mono-, di-, and oligosaccharides); multiple quantitative, each specimen ","code_information":[{"code":"84379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.30,"maximum":110.88,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":110.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":110.88,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":106.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.30,"methodology":"fee schedule"}]}]},{"description":"Testosterone; free ","code_information":[{"code":"84402","type":"CPT"},{"code":"902702","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":14.25,"maximum":26.74,"gross_charge":727.80,"discounted_cash":727.80,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":26.74,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":25.22,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":25.98,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":25.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":24.96,"methodology":"fee schedule"}]}]},{"description":"Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to red ","code_information":[{"code":"L0467","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":183.72,"maximum":196.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":187.47,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":187.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":187.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":187.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":187.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":187.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":187.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":187.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":187.47,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":196.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":187.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":185.60,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":191.22,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":187.47,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":187.47,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":187.47,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":187.47,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":187.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":183.72,"methodology":"fee schedule"}]}]},{"description":"Trimethylamine/trimethylamine N-oxide (TMA/TMAO) profile, tandem mass spectrometry (MS/MS), urine, with algorithmic analysis and interpretive report ","code_information":[{"code":"0256U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":156.75,"maximum":167.95,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":167.95,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":158.35,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":163.15,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":159.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":156.75,"methodology":"fee schedule"}]}]},{"description":"Upper extremity addition, frame type socket, above elbow or elbow disarticulation ","code_information":[{"code":"L6688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":608.50,"maximum":651.97,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":651.97,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":614.71,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":633.34,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":620.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":608.50,"methodology":"fee schedule"}]}]},{"description":"Urinalysis; bacteriuria screen, except by culture or dipstick ","code_information":[{"code":"81007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8.55,"maximum":31.48,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":31.48,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":29.68,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":30.58,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8.55,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":29.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":29.38,"methodology":"fee schedule"}]}]},{"description":"Antibody; Coccidioides ","code_information":[{"code":"86635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.24,"maximum":36.63,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.36,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":11.70,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":11.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.24,"methodology":"fee schedule"}]}]},{"description":"Antinuclear antibodies (ANA); ","code_information":[{"code":"86038","type":"CPT"},{"code":"902965","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.85,"maximum":52.47,"gross_charge":492.16,"discounted_cash":492.16,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.97,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.33,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.85,"methodology":"fee schedule"}]}]},{"description":"BCKDHB (branched-chain keto acid dehydrogenase E1, beta polypeptide) (eg, maple syrup urine disease) gene analysis, common variants (eg, R183P, G278S, E422X) ","code_information":[{"code":"81205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":93.09,"maximum":2231.46,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":94.99,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":94.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":94.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":94.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":94.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":94.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":94.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":94.99,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":94.99,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":99.74,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":94.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":94.04,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":96.89,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":94.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2231.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2231.46,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":94.99,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2141.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":94.99,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":94.99,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":94.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":93.09,"methodology":"fee schedule"}]}]},{"description":"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count ","code_information":[{"code":"85025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.61,"maximum":13.86,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":8.16,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7.69,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":7.93,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":7.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7.61,"methodology":"fee schedule"}]}]},{"description":"Calculus; infrared spectroscopy ","code_information":[{"code":"82365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.64,"maximum":37.62,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.16,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":37.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":37.62,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":36.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.64,"methodology":"fee schedule"}]}]},{"description":"Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf ","code_information":[{"code":"L0172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":142.20,"maximum":152.35,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":145.10,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":145.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":145.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":145.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":145.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":145.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":145.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":145.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":145.10,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":152.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":145.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":143.65,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":148.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":145.10,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":145.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":145.10,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":145.10,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":145.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":142.20,"methodology":"fee schedule"}]}]},{"description":"Citrate ","code_information":[{"code":"82507","type":"CPT"},{"code":"902758","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":20.90,"maximum":29.19,"gross_charge":1070.84,"discounted_cash":1070.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":27.80,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":27.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":27.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":27.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":27.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":27.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":27.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":27.80,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":27.80,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":29.19,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":27.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":27.52,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":28.36,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":27.80,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21.78,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":27.80,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":27.80,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":27.80,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":27.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":27.24,"methodology":"fee schedule"}]}]},{"description":"Collagen dressing, sterile, size 16 sq. in. or less, each ","code_information":[{"code":"A6021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28.12,"maximum":30.12,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":30.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":28.40,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":29.26,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":28.12,"methodology":"fee schedule"}]}]},{"description":"Cortisol; free ","code_information":[{"code":"82530","type":"CPT"},{"code":"902689","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":16.38,"maximum":79.20,"gross_charge":578.63,"discounted_cash":578.63,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.54,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":17.04,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":79.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":79.20,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":76.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16.38,"methodology":"fee schedule"}]}]},{"description":"Culture, chlamydia, any source ","code_information":[{"code":"87110","type":"CPT"},{"code":"902936","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":19.21,"maximum":58.41,"gross_charge":590.60,"discounted_cash":590.60,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":20.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":19.99,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":58.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":58.41,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":56.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":19.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19.21,"methodology":"fee schedule"}]}]},{"description":"Deoxycortisol, 11- ","code_information":[{"code":"82634","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25.65,"maximum":30.74,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":30.74,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":28.99,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":29.87,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":25.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":29.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":28.69,"methodology":"fee schedule"}]}]},{"description":"Elbow disarticulation, external power, molded inner socket, removable humeral shell, outside locking hinges, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectroni ","code_information":[{"code":"L6945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15632.96,"maximum":16749.60,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":15952.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":15952.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":15952.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":15952.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":15952.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":15952.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":15952.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":15952.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":15952.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":16749.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":15952.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":15792.48,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16271.04,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":15952.00,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":15952.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":15952.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":15952.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":15952.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15632.96,"methodology":"fee schedule"}]}]},{"description":"Estriol ","code_information":[{"code":"82677","type":"CPT"},{"code":"902718","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":23.70,"maximum":53.46,"gross_charge":775.53,"discounted_cash":775.53,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":23.94,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":24.66,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":51.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":24.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":23.70,"methodology":"fee schedule"}]}]},{"description":"Fibrinolytic factors and inhibitors; plasminogen, antigenic assay ","code_information":[{"code":"85421","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.98,"maximum":21.78,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21.78,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9.98,"methodology":"fee schedule"}]}]},{"description":"FXN (frataxin), gene analysis, including small sequence changes in exonic and intronic regions, deletions, duplications, short tandem requests (STR) expansions, mobile element insertions, and variants ","code_information":[{"code":"0233U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":269.33,"maximum":786.06,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":272.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":786.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":786.06,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":754.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":269.33,"methodology":"fee schedule"}]}]},{"description":"Gauze, impregnated, other than water, normal saline, or zinc paste, sterile, any width, per linear yard ","code_information":[{"code":"A6266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2.56,"maximum":2.74,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2.74,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2.58,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2.66,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2.56,"methodology":"fee schedule"}]}]},{"description":"Gradient compression garment, genital region, each ","code_information":[{"code":"A6570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":104.95,"maximum":112.44,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":112.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":106.02,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":109.23,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":107.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":104.95,"methodology":"fee schedule"}]}]},{"description":"Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf ","code_information":[{"code":"L3918","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":112.04,"maximum":120.05,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":120.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":113.19,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":116.62,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":114.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":112.04,"methodology":"fee schedule"}]}]},{"description":"Heparin-protamine tolerance test ","code_information":[{"code":"85530","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.83,"maximum":26.73,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.74,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12.96,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.35,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":25.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":13.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.83,"methodology":"fee schedule"}]}]},{"description":"HLA Class I typing, low resolution (eg, antigen equivalents); one locus (eg, HLA-A, -B, or -C), each ","code_information":[{"code":"81373","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":124.88,"maximum":928.62,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":133.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":126.16,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":129.98,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":928.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":928.62,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":891.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":127.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":124.88,"methodology":"fee schedule"}]}]},{"description":"Human Platelet Antigen 2 genotyping (HPA-2), GP1BA (glycoprotein Ib ºplatelet», alpha polypeptide ºGPIba») (eg, neonatal alloimmune thrombocytopenia ºNAIT», post-transfusion purpura), gene analysis, c ","code_information":[{"code":"81106","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.35,"maximum":128.33,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":128.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":121.00,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":124.66,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":122.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":119.78,"methodology":"fee schedule"}]}]},{"description":"Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee ","code_information":[{"code":"L5460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":659.18,"maximum":706.26,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":706.26,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":665.90,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":686.08,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":672.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":659.18,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay ºEIA», enzyme-linked immunosorbent assay ºELISA», fluorescence immunoassay ºFIA», immunochemiluminometric assay ºIMC ","code_information":[{"code":"87385","type":"CPT"},{"code":"902940","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.98,"maximum":28.71,"gross_charge":360.94,"discounted_cash":360.94,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":28.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":28.71,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":27.55,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.98,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism ","code_information":[{"code":"87798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34.39,"maximum":56.43,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":56.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":56.43,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":34.39,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique ","code_information":[{"code":"87661","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34.39,"maximum":99.99,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":95.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":34.39,"methodology":"fee schedule"}]}]},{"description":"Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation ","code_information":[{"code":"A4316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":37.98,"maximum":40.69,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":40.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":38.36,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":39.52,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":38.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":37.98,"methodology":"fee schedule"}]}]},{"description":"Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise ","code_information":[{"code":"L1810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":108.87,"maximum":116.64,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":116.64,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":109.98,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":113.31,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":111.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":108.87,"methodology":"fee schedule"}]}]},{"description":"Lightweight portable motorized/power wheelchair ","code_information":[{"code":"K0012","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":434.46,"maximum":465.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":443.33,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":443.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":443.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":443.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":443.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":443.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":443.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":443.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":443.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":465.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":443.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":438.90,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":452.20,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":443.33,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":443.33,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":443.33,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":443.33,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":443.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":434.46,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, foam filled caster tire, any size, each ","code_information":[{"code":"E2217","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":45.41,"maximum":48.66,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":48.66,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":45.88,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":47.27,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":46.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":45.41,"methodology":"fee schedule"}]}]},{"description":"Microsomal antibodies (eg, thyroid or liver-kidney), each ","code_information":[{"code":"86376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.26,"maximum":33.66,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":15.28,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14.40,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":32.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":14.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14.26,"methodology":"fee schedule"}]}]},{"description":"Neurology (autism), 32 amines by LC-MS/MS, using plasma, algorithm reported as metabolic signature associated with autism spectrum disorder ","code_information":[{"code":"0063U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":735.00,"maximum":2145.33,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":787.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":742.50,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":765.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2145.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2145.33,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2058.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":735.00,"methodology":"fee schedule"}]}]},{"description":"NUDT15 (nudix hydrolase 15) and TPMT (thiopurine S-methyltransferase) (eg, drug metabolism) gene analysis, common variants ","code_information":[{"code":"0169U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":456.85,"maximum":1333.53,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":489.48,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":461.51,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":475.49,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1333.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1333.53,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1279.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":466.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":456.85,"methodology":"fee schedule"}]}]},{"description":"Oncology (lung), mRNA, quantitative PCR analysis of 11 genes (BAG1,BRCA1,CDC6, CDK2AP1, ERBB3, FUT3, IL11, LCK, RND3, SH3BGR, WNT3A) and 3 reference genes (ESD, TBP, YAP1), formalin-fixed paraffin emb ","code_information":[{"code":"0288U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3795.54,"maximum":4066.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3834.27,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3795.54,"methodology":"fee schedule"}]}]},{"description":"Orthopedic shoe addition, insole, rubber ","code_information":[{"code":"L3510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":34.07,"maximum":36.51,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34.42,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":35.47,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":34.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":34.07,"methodology":"fee schedule"}]}]},{"description":"Ostomy pouch, urinary, with faceplate attached, plastic, each ","code_information":[{"code":"A4379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":20.08,"maximum":21.51,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":21.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":20.29,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":20.90,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":20.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":20.08,"methodology":"fee schedule"}]}]},{"description":"Pessary, reusable, non rubber, any type ","code_information":[{"code":"A4562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":68.81,"maximum":73.72,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":70.21,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":70.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":70.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":70.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":70.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":70.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":70.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":70.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":70.21,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":73.72,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":70.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":69.51,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":71.61,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":70.21,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":70.21,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":70.21,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":70.21,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":70.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":68.81,"methodology":"fee schedule"}]}]},{"description":"Lenticular, (myodisc), per lens, trifocal ","code_information":[{"code":"V2315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":137.05,"maximum":146.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":139.85,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":139.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":139.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":139.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":139.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":139.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":139.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":139.85,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":139.85,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":146.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":139.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":138.45,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":142.65,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":139.85,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":139.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":139.85,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":139.85,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":139.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":137.05,"methodology":"fee schedule"}]}]},{"description":"Manganese ","code_information":[{"code":"83785","type":"CPT"},{"code":"946926","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":26.12,"maximum":97.02,"gross_charge":310.20,"discounted_cash":310.20,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":27.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":26.38,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":27.18,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":97.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":97.02,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":93.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":26.12,"methodology":"fee schedule"}]}]},{"description":"Metatarsal bar wedge, rocker ","code_information":[{"code":"L3400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":47.40,"maximum":50.79,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":50.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":47.89,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":49.34,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":48.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":47.40,"methodology":"fee schedule"}]}]},{"description":"MSH6 (mutS homolog 6) (eg, hereditary colon cancer, Lynch syndrome) mRNA sequence analysis (List separately in addition to code for primary procedure) ","code_information":[{"code":"0160U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":277.22,"maximum":808.83,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":297.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":280.05,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":808.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":808.83,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":776.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":277.22,"methodology":"fee schedule"}]}]},{"description":"Non-implanted pelvic floor electrical stimulator, complete system ","code_information":[{"code":"E0740","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":69.92,"maximum":74.92,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":71.35,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":71.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":71.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":71.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":71.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":71.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":71.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":71.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":71.35,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":74.92,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":71.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":70.64,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":72.78,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":71.35,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":71.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":71.35,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":71.35,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":71.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":69.92,"methodology":"fee schedule"}]}]},{"description":"Oncology (diffuse large B-cell lymphoma ºDLBCL»), mRNA, gene expression profiling by fluorescent probe hybridization of 20 genes, formalin-fixed paraffin-embedded tissue, algorithm reported as cell of ","code_information":[{"code":"0017M","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2460.01,"maximum":7181.46,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2635.72,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2485.11,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2560.41,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7181.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7181.46,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":6891.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2510.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2460.01,"methodology":"fee schedule"}]}]},{"description":"Oncology (solid organ neoplasia), DNA, targeted sequencing of protein-coding exons of 468 cancer-associated genes, including interrogation for somatic mutations and microsatellite instability, matched ","code_information":[{"code":"0048U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2861.21,"maximum":8352.63,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3065.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2890.40,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2977.99,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8352.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8352.63,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8015.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2919.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2861.21,"methodology":"fee schedule"}]}]},{"description":"Ostomy irrigation supply; bag, each ","code_information":[{"code":"A4398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":18.16,"maximum":19.46,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":18.90,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":18.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18.16,"methodology":"fee schedule"}]}]},{"description":"Patient lift, fixed system, includes all components/accessories ","code_information":[{"code":"E0640","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":149.17,"maximum":159.82,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":152.21,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":152.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":152.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":152.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":152.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":152.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":152.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":152.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":152.21,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":159.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":152.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":150.69,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":155.25,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":152.21,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":152.21,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":152.21,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":152.21,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":152.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":149.17,"methodology":"fee schedule"}]}]},{"description":"PIK3CA (phosphatidylinositol-4, 5-biphosphate 3-kinase, catalytic subunit alpha) (eg, colorectal and breast cancer) gene analysis, targeted sequence analysis (eg, exons 7, 9, 20) ","code_information":[{"code":"81309","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":269.33,"maximum":500.94,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":272.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":500.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":500.94,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":480.70,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":269.33,"methodology":"fee schedule"}]}]},{"description":"Power operated vehicle, group 1 standard, patient weight capacity up to and including 300 pounds ","code_information":[{"code":"K0800","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":942.39,"maximum":1009.70,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":961.62,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":961.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":961.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":961.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":961.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":961.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":961.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":961.62,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":961.62,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1009.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":961.62,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":952.00,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":980.85,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":961.62,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":961.62,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":961.62,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":961.62,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":961.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":942.39,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair, group 1 standard, portable, sling/solid seat and back, patient weight capacity up to and including 300 pounds ","code_information":[{"code":"K0813","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":302.26,"maximum":323.85,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":308.43,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":308.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":308.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":308.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":308.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":308.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":308.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":308.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":308.43,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":323.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":308.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":305.35,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":314.60,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":308.43,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":308.43,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":308.43,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":308.43,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":308.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":302.26,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair, group 3 very heavy duty, sling/solid seat/back, patient weight capacity 451 to 600 pounds ","code_information":[{"code":"K0852","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":1224.38,"maximum":1311.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1249.37,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1249.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1249.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1249.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1249.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1249.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1249.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1249.37,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1249.37,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1311.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1249.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1236.88,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1274.36,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1249.37,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1249.37,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1249.37,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1249.37,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1249.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1224.38,"methodology":"fee schedule"}]}]},{"description":"Procalcitonin (PCT) ","code_information":[{"code":"84145","type":"CPT"},{"code":"952216","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":26.68,"maximum":59.40,"gross_charge":181.18,"discounted_cash":181.18,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":28.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":26.95,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":27.76,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":59.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":59.40,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":57.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":26.68,"methodology":"fee schedule"}]}]},{"description":"Pyridoxal phosphate (Vitamin B-6) ","code_information":[{"code":"84207","type":"CPT"},{"code":"902732","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":27.54,"maximum":83.16,"gross_charge":806.60,"discounted_cash":806.60,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":29.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":27.82,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":28.66,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":83.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":83.16,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":79.80,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":28.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":27.54,"methodology":"fee schedule"}]}]},{"description":"Replace molded thigh lacer, for custom fabricated orthosis only ","code_information":[{"code":"L4040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":459.42,"maximum":492.24,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":468.80,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":468.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":468.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":468.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":468.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":468.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":468.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":468.80,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":468.80,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":492.24,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":468.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":464.11,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":478.18,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":468.80,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":468.80,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":468.80,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":468.80,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":468.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":459.42,"methodology":"fee schedule"}]}]},{"description":"Replacement, socket, below knee, molded to patient model ","code_information":[{"code":"L5700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3259.49,"maximum":3492.31,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3326.01,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3326.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3326.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3326.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3326.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3326.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3326.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3326.01,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3326.01,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3492.31,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3326.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3292.75,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3392.53,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3326.01,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3326.01,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3326.01,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3326.01,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3326.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3259.49,"methodology":"fee schedule"}]}]},{"description":"Seat lift mechanism, non-electric, any type ","code_information":[{"code":"E0629","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":328.63,"maximum":352.11,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":352.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":331.99,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":342.05,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":335.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":328.63,"methodology":"fee schedule"}]}]},{"description":"Sickling of RBC, reduction ","code_information":[{"code":"85660","type":"CPT"},{"code":"903413","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.40,"maximum":26.73,"gross_charge":89.47,"discounted_cash":89.47,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.45,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.62,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":25.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.40,"methodology":"fee schedule"}]}]},{"description":"Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 2.25d to 4.00d cylinder, per lens ","code_information":[{"code":"V2112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":63.95,"maximum":68.52,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":65.26,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":65.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":65.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":65.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":65.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":65.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":65.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":65.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":65.26,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":68.52,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":65.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":64.61,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":66.57,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":65.26,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":65.26,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":65.26,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":65.26,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":65.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":63.95,"methodology":"fee schedule"}]}]},{"description":"Stem cells (ie, CD34), total count ","code_information":[{"code":"86367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":73.15,"maximum":81.67,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":81.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":77.00,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":79.34,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":76.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":76.23,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":73.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":77.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":76.22,"methodology":"fee schedule"}]}]},{"description":"Tlso, triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine ","code_information":[{"code":"L0486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2332.78,"maximum":2499.41,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2380.39,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2380.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2380.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2380.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2380.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2380.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2380.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2380.39,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2380.39,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2499.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2380.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2356.59,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2428.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2380.39,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2380.39,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2380.39,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2380.39,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2380.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2332.78,"methodology":"fee schedule"}]}]},{"description":"Transferase; alanine amino (ALT) (SGPT) ","code_information":[{"code":"84460","type":"CPT"},{"code":"902484","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.19,"maximum":144.54,"gross_charge":250.56,"discounted_cash":250.56,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.25,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.41,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":144.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":144.54,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":138.70,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.19,"methodology":"fee schedule"}]}]},{"description":"Upper extremity addition, shoulder lock mechanism, body powered actuator ","code_information":[{"code":"L6647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":606.53,"maximum":649.86,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":618.91,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":618.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":618.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":618.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":618.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":618.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":618.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":618.91,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":618.91,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":649.86,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":618.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":612.72,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":631.29,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":618.91,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":618.91,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":618.91,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":618.91,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":618.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":606.53,"methodology":"fee schedule"}]}]},{"description":"Vitamin D, 25 hydroxy D2 and D3, by LC-MS/MS, serum microsample, quantitative ","code_information":[{"code":"0038U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29.01,"maximum":84.15,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":31.08,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":29.30,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":30.19,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":84.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":84.15,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":80.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":29.01,"methodology":"fee schedule"}]}]},{"description":"Wheelchair accessory, tray, each ","code_information":[{"code":"E0950","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":90.06,"maximum":96.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":91.90,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":91.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":91.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":91.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":91.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":91.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":91.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":91.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":91.90,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":96.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":91.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":90.98,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":93.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":91.90,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":91.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":91.90,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":91.90,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":91.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":90.06,"methodology":"fee schedule"}]}]},{"description":"Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf ","code_information":[{"code":"L3908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":63.21,"maximum":67.73,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":64.50,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":64.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":64.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":64.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":64.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":64.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":64.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":64.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":64.50,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":67.73,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":64.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":63.85,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":65.79,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":64.50,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":64.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":64.50,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":64.50,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":64.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":63.21,"methodology":"fee schedule"}]}]},{"description":"Power operated vehicle, group 2 heavy duty, patient weight capacity 301 to 450 pounds ","code_information":[{"code":"K0807","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":2510.90,"maximum":2690.25,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2562.14,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2562.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2562.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2562.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2562.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2562.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2562.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2562.14,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2562.14,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2690.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2562.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2536.52,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2613.38,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2562.14,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2562.14,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2562.14,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2562.14,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2562.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2510.90,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair, group 2 extra heavy duty, single power option, sling/solid seat/back, patient weight capacity 601 pounds or more ","code_information":[{"code":"K0840","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":1088.95,"maximum":1166.73,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1111.17,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1111.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1111.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1111.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1111.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1111.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1111.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1111.17,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1111.17,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1166.73,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1111.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1100.06,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1133.39,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1111.17,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1111.17,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1111.17,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1111.17,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1111.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1088.95,"methodology":"fee schedule"}]}]},{"description":"Preparatory, below knee 'ptb' type socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, molded to model ","code_information":[{"code":"L5530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2173.87,"maximum":2329.14,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2218.23,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2218.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2218.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2218.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2218.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2218.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2218.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2218.23,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2218.23,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2329.14,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2218.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2196.05,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2262.59,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2218.23,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2218.23,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2218.23,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2218.23,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2218.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2173.87,"methodology":"fee schedule"}]}]},{"description":"Quinine ","code_information":[{"code":"84228","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.40,"maximum":76.23,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.21,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.51,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":76.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":76.23,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":73.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":11.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.40,"methodology":"fee schedule"}]}]},{"description":"Replace leather cuff kafo, proximal thigh ","code_information":[{"code":"L4100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":112.46,"maximum":120.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":114.76,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":114.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":114.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":114.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":114.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":114.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":114.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":114.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":114.76,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":120.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":114.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":113.61,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":117.06,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":114.76,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":114.76,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":114.76,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":114.76,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":114.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":112.46,"methodology":"fee schedule"}]}]},{"description":"Rheumatoid factor; qualitative ","code_information":[{"code":"86430","type":"CPT"},{"code":"902982","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":6.02,"maximum":38.61,"gross_charge":107.40,"discounted_cash":107.40,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":6.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":6.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":6.26,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":6.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":6.02,"methodology":"fee schedule"}]}]},{"description":"Six volt battery, each ","code_information":[{"code":"L7360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":261.21,"maximum":279.87,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":266.54,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":266.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":266.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":266.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":266.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":266.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":266.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":266.54,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":266.54,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":279.87,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":266.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":263.87,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":271.87,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":266.54,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":266.54,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":266.54,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":266.54,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":266.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":261.21,"methodology":"fee schedule"}]}]},{"description":"Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens ","code_information":[{"code":"V2102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":88.93,"maximum":95.28,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":95.28,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":89.83,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":92.55,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":90.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":88.93,"methodology":"fee schedule"}]}]},{"description":"Supplies for external non-insulin drug infusion pump, syringe type cartridge, sterile, each ","code_information":[{"code":"K0552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3.21,"maximum":3.44,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3.25,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3.21,"methodology":"fee schedule"}]}]},{"description":"Tape, non-waterproof, per 18 square inches ","code_information":[{"code":"A4450","type":"HCPCS"}],"standard_charges":[{"modifiers":"AU","modifiers_description":"Item furnished in conjunction with a urological, ostomy, or tracheostomy supply","setting":"outpatient","minimum":0.10,"maximum":0.11,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":0.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":0.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":0.10,"methodology":"fee schedule"}]}]},{"description":"Thromboplastin inhibition, tissue ","code_information":[{"code":"85705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.65,"maximum":10.11,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":10.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9.53,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":6.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":9.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9.44,"methodology":"fee schedule"}]}]},{"description":"Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, res ","code_information":[{"code":"L0457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":469.77,"maximum":503.33,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":479.36,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":479.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":479.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":479.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":479.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":479.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":479.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":479.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":479.36,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":503.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":479.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":474.57,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":488.95,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":479.36,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":479.36,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":479.36,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":479.36,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":479.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":469.77,"methodology":"fee schedule"}]}]},{"description":"Tracheostomy/laryngectomy tube, non-cuffed, polyvinylchloride (pvc), silicone or equal, each ","code_information":[{"code":"A7520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":63.48,"maximum":68.02,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":68.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":64.13,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":66.08,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":64.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":63.48,"methodology":"fee schedule"}]}]},{"description":"Truss, addition to standard pad, water pad ","code_information":[{"code":"L8320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":61.40,"maximum":65.78,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":65.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":62.02,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":63.90,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":62.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":61.40,"methodology":"fee schedule"}]}]},{"description":"Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automate ","code_information":[{"code":"81002","type":"CPT"},{"code":"946817","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":3.41,"maximum":255.42,"gross_charge":53.71,"discounted_cash":53.71,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":245.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3.41,"methodology":"fee schedule"}]}]},{"description":"Walker, enclosed, four sided framed, rigid or folding, wheeled with posterior seat ","code_information":[{"code":"E0144","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":31.83,"maximum":34.10,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":34.10,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":32.16,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":33.13,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":32.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":31.83,"methodology":"fee schedule"}]}]},{"description":"Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each ","code_information":[{"code":"E0955","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":16.49,"maximum":17.67,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.66,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":17.17,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16.49,"methodology":"fee schedule"}]}]},{"description":"Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, custom fabricated, includes fitting and adjustmen ","code_information":[{"code":"L3806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":481.91,"maximum":516.34,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":516.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":486.83,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":501.59,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":481.91,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity orthosis, drop lock retainer, each ","code_information":[{"code":"L2785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":34.17,"maximum":36.61,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36.61,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34.52,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":35.57,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":34.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":34.17,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, below knee, leather socket ","code_information":[{"code":"L5638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":745.35,"maximum":798.59,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":760.56,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":760.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":760.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":760.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":760.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":760.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":760.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":760.56,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":760.56,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":798.59,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":760.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":752.95,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":775.77,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":760.56,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":760.56,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":760.56,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":760.56,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":760.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":745.35,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, straight knee joint, heavy duty, each joint ","code_information":[{"code":"L2385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":192.55,"maximum":206.30,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":196.48,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":196.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":196.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":196.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":196.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":196.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":196.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":196.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":196.48,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":206.30,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":196.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":194.52,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":200.41,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":196.48,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":196.48,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":196.48,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":196.48,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":196.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":192.55,"methodology":"fee schedule"}]}]},{"description":"Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mech ","code_information":[{"code":"L6695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":725.23,"maximum":777.03,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":740.03,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":740.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":740.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":740.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":740.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":740.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":740.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":740.03,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":740.03,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":777.03,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":740.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":732.63,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":754.83,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":740.03,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":740.03,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":740.03,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":740.03,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":740.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":725.23,"methodology":"fee schedule"}]}]},{"description":"Air pressure pad for mattress, standard mattress length and width ","code_information":[{"code":"E0197","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":21.32,"maximum":22.85,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":22.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":21.54,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":22.20,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":21.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":21.32,"methodology":"fee schedule"}]}]},{"description":"Amniotic fluid scan (spectrophotometric) ","code_information":[{"code":"82143","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.16,"maximum":46.53,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":9.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9.26,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":9.54,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":9.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9.16,"methodology":"fee schedule"}]}]},{"description":"Antibody identification; platelet antibodies ","code_information":[{"code":"86022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.00,"maximum":22.77,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19.29,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":18.19,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":18.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":18.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18.00,"methodology":"fee schedule"}]}]},{"description":"Antibody; influenza virus ","code_information":[{"code":"86710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.28,"maximum":30.69,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":14.23,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13.41,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.82,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":30.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":30.69,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":29.45,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":13.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":13.28,"methodology":"fee schedule"}]}]},{"description":"ATXN8OS (ATXN8 opposite strand ºnon-protein coding») (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles ","code_information":[{"code":"81182","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134.26,"maximum":391.05,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":135.63,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":391.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":391.05,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":375.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":134.26,"methodology":"fee schedule"}]}]},{"description":"Bilirubin; feces, qualitative ","code_information":[{"code":"82252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.47,"maximum":48.51,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.51,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4.65,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":46.55,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.47,"methodology":"fee schedule"}]}]},{"description":"Borrelia burgdorferi (Lyme disease), OspA protein evaluation, urine ","code_information":[{"code":"0316U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.29,"maximum":19.59,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19.59,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":18.47,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":19.03,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":18.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18.29,"methodology":"fee schedule"}]}]},{"description":"Cardiac ion channelopathies (eg, Brugada syndrome, long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia); genomic sequence analysis panel, must include sequencing ","code_information":[{"code":"81413","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":573.20,"maximum":5722.20,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":614.14,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":579.05,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":596.60,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5722.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5722.20,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5491.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":584.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":573.20,"methodology":"fee schedule"}]}]},{"description":"Cast supplies, short arm splint, pediatric (0-10 years), fiberglass ","code_information":[{"code":"Q4024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7.28,"maximum":7.80,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":7.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7.36,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":7.58,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":7.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7.28,"methodology":"fee schedule"}]}]},{"description":"Chloride; urine ","code_information":[{"code":"82436","type":"CPT"},{"code":"902513","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.63,"maximum":30.69,"gross_charge":405.65,"discounted_cash":405.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":6.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.69,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.87,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":30.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":30.69,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":29.45,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.63,"methodology":"fee schedule"}]}]},{"description":"Coagulation time; Lee and White ","code_information":[{"code":"85345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.60,"maximum":43.56,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4.92,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4.78,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":43.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":43.56,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":41.80,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.60,"methodology":"fee schedule"}]}]},{"description":"Continent device; catheter for continent stoma ","code_information":[{"code":"A5082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15.92,"maximum":17.05,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16.56,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15.92,"methodology":"fee schedule"}]}]},{"description":"Culture, typing; gas liquid chromatography (GLC) or high pressure liquid chromatography (HPLC) method ","code_information":[{"code":"87143","type":"CPT"},{"code":"947217","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.27,"maximum":55.44,"gross_charge":492.16,"discounted_cash":492.16,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":53.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.27,"methodology":"fee schedule"}]}]},{"description":"Cytopathology, slides, cervical or vaginal; manual screening under physician supervision ","code_information":[{"code":"88150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.40,"maximum":57.42,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":18.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":17.58,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":18.12,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":55.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":17.40,"methodology":"fee schedule"}]}]},{"description":"Emergency hand pump for use with electric or electric/pneumatic ventricular assist device, replacement only ","code_information":[{"code":"Q0494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":251.13,"maximum":269.06,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":256.25,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":256.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":256.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":256.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":256.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":256.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":256.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":256.25,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":256.25,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":269.06,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":256.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":253.69,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":261.38,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":256.25,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":256.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":256.25,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":256.25,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":256.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":251.13,"methodology":"fee schedule"}]}]},{"description":"Fat differential, feces, quantitative ","code_information":[{"code":"82715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22.51,"maximum":42.57,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":24.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":23.43,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22.51,"methodology":"fee schedule"}]}]},{"description":"For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe ","code_information":[{"code":"A5506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":43.37,"maximum":46.46,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":46.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":43.81,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":45.13,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":44.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":43.37,"methodology":"fee schedule"}]}]},{"description":"General use wheelchair seat cushion, width less than 22 inches, any depth ","code_information":[{"code":"E2601","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":42.08,"maximum":45.09,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":45.09,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":42.51,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":43.80,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":42.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":42.08,"methodology":"fee schedule"}]}]},{"description":"Gradient compression stocking, waist length, 18-30 mmhg, custom, each ","code_information":[{"code":"A6562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":940.68,"maximum":1007.87,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1007.87,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":950.28,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":979.08,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":940.68,"methodology":"fee schedule"}]}]},{"description":"Heavy duty wheelchair ","code_information":[{"code":"K0006","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":78.56,"maximum":84.17,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":84.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":79.36,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":81.76,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":80.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":78.56,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin; by copper sulfate method, non-automated ","code_information":[{"code":"83026","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3.93,"maximum":59.40,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":59.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":59.40,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":57.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3.93,"methodology":"fee schedule"}]}]},{"description":"Insulin antibodies ","code_information":[{"code":"86337","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20.98,"maximum":69.30,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":21.20,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":21.84,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":69.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":69.30,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":66.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":21.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":20.98,"methodology":"fee schedule"}]}]},{"description":"Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk) ","code_information":[{"code":"L1860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1156.95,"maximum":1239.59,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1180.56,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1180.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1180.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1180.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1180.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1180.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1180.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1180.56,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1180.56,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1239.59,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1180.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1168.75,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1204.17,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1180.56,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1180.56,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1180.56,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1180.56,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1180.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1156.95,"methodology":"fee schedule"}]}]},{"description":"Leukocyte histamine release test (LHR) ","code_information":[{"code":"86343","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.21,"maximum":44.55,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":42.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.21,"methodology":"fee schedule"}]}]},{"description":"Lumbar-sacral orthosis, sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction t ","code_information":[{"code":"L0635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1032.03,"maximum":1105.74,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1053.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1053.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1053.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1053.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1053.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1053.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1053.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1053.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1053.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1105.74,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1053.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1042.56,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1074.15,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1053.09,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1053.09,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1053.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1053.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1053.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1032.03,"methodology":"fee schedule"}]}]},{"description":"Monitor/display module for use with electric or electric/pneumatic ventricular assist device, replacement only ","code_information":[{"code":"Q0484","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4261.28,"maximum":4565.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4348.24,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4348.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4348.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4348.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4348.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4348.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4348.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4348.24,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4348.24,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4565.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4348.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4304.76,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4435.20,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4348.24,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4348.24,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4348.24,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4348.24,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4348.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4261.28,"methodology":"fee schedule"}]}]},{"description":"Nephrology (diabetic chronic kidney disease), multiplex electrochiluminescent immunoassay of soluble tumor necrosis factor receptor 1, 2, and kidney injury molecule 1 combined with clinical data, plas ","code_information":[{"code":"0407U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":931.00,"maximum":997.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":997.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":940.50,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":969.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":931.00,"methodology":"fee schedule"}]}]},{"description":"Non-pneumatic compression controller with sequential calibrated gradient pressure ","code_information":[{"code":"E0680","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":645.41,"maximum":691.51,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":658.58,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":658.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":658.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":658.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":658.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":658.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":658.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":658.58,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":658.58,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":691.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":658.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":651.99,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":671.75,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":658.58,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":658.58,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":658.58,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":658.58,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":658.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":645.41,"methodology":"fee schedule"}]}]},{"description":"Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 11 genes (7 content and 4 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithms reported as percentage ","code_information":[{"code":"81518","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":420.85,"maximum":4066.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4066.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3834.27,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3950.46,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":438.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":438.57,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":420.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3873.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3795.54,"methodology":"fee schedule"}]}]},{"description":"Oncology (pan-tumor), genetic profiling of 8 DNA-regulatory markers by qPCR, whole blood, reported as a high or low probability of responding to immune checkpoint-inhibitor therapy ","code_information":[{"code":"0332U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1119.22,"maximum":1199.16,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1199.16,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1130.64,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1164.90,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1142.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1119.22,"methodology":"fee schedule"}]}]},{"description":"Osmotic fragility, RBC; incubated ","code_information":[{"code":"85557","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.09,"maximum":23.76,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":14.03,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13.23,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.63,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":23.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":23.76,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":22.80,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":13.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":13.09,"methodology":"fee schedule"}]}]},{"description":"Ostomy ring, each ","code_information":[{"code":"A4404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2.24,"maximum":2.40,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2.27,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2.24,"methodology":"fee schedule"}]}]},{"description":"Pail or pan for use with commode chair, replacement only ","code_information":[{"code":"E0167","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":11.63,"maximum":12.46,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.75,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":11.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.63,"methodology":"fee schedule"}]}]},{"description":"Phosphatase, acid; prostatic ","code_information":[{"code":"84066","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.47,"maximum":55.44,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":10.14,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9.56,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":9.85,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":53.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9.47,"methodology":"fee schedule"}]}]},{"description":"Post-coital direct, qualitative examinations of vaginal or cervical mucous ","code_information":[{"code":"Q0115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24.50,"maximum":45.54,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":26.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":25.50,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":45.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":45.54,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":24.50,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, group 34 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) ","code_information":[{"code":"E2359","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":186.70,"maximum":200.04,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":190.51,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":190.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":190.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":190.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":190.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":190.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":190.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":190.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":190.51,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":200.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":190.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":188.60,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":194.32,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":190.51,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":190.51,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":190.51,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":190.51,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":190.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":186.70,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair, group 3 very heavy duty, captains chair, patient weight capacity 451 to 600 pounds ","code_information":[{"code":"K0853","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":1257.76,"maximum":1347.60,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1283.43,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1283.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1283.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1283.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1283.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1283.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1283.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1283.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1283.43,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1347.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1283.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1270.60,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1309.10,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1283.43,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1283.43,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1283.43,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1283.43,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1283.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1257.76,"methodology":"fee schedule"}]}]},{"description":"Prescription drug monitoring, evaluation of drugs present by LC-MS/MS, using oral fluid, reported as a comparison to an estimated steady-state range, per date of service including all drug compounds a ","code_information":[{"code":"0011U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":112.14,"maximum":326.70,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":120.15,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":113.29,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":116.72,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":326.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":326.70,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":313.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":114.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":112.14,"methodology":"fee schedule"}]}]},{"description":"Regulator ","code_information":[{"code":"E1353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":37.87,"maximum":40.57,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":40.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":38.25,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":39.41,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":38.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":37.87,"methodology":"fee schedule"}]}]},{"description":"Reticulated platelet assay ","code_information":[{"code":"85055","type":"CPT"},{"code":"958764","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":10.45,"maximum":37.53,"gross_charge":63.25,"discounted_cash":63.25,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":37.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":35.38,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":36.45,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10.89,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10.45,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":35.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":35.03,"methodology":"fee schedule"}]}]},{"description":"SEPT9 (Septin9) (eg, colorectal cancer) promoter methylation analysis ","code_information":[{"code":"81327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":188.16,"maximum":858.33,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":201.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":190.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":195.84,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":858.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":858.33,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":823.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":192.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":188.16,"methodology":"fee schedule"}]}]},{"description":"Skin protection and positioning wheelchair seat cushion, width 22 inches or greater, any depth ","code_information":[{"code":"E2608","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":288.44,"maximum":309.05,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":294.33,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":294.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":294.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":294.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":294.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":294.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":294.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":294.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":294.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":309.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":294.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":291.39,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":300.22,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":294.33,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":294.33,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":294.33,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":294.33,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":294.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":288.44,"methodology":"fee schedule"}]}]},{"description":"Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing ","code_information":[{"code":"A6255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4.07,"maximum":4.36,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4.36,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.11,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4.23,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.07,"methodology":"fee schedule"}]}]},{"description":"Static progressive stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories ","code_information":[{"code":"E1816","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":182.18,"maximum":195.20,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":195.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":184.04,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":189.62,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":185.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":182.18,"methodology":"fee schedule"}]}]},{"description":"Thrombin time; plasma ","code_information":[{"code":"85670","type":"CPT"},{"code":"903363","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.65,"maximum":27.72,"gross_charge":274.43,"discounted_cash":274.43,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26.60,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.65,"methodology":"fee schedule"}]}]},{"description":"TPMT (thiopurine S-methyltransferase) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3) ","code_information":[{"code":"81335","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":139.65,"maximum":183.55,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":183.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":173.06,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":178.31,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":145.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":145.53,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":139.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":174.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":171.31,"methodology":"fee schedule"}]}]},{"description":"Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar ","code_information":[{"code":"E0911","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":48.91,"maximum":52.41,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":52.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":49.41,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":48.91,"methodology":"fee schedule"}]}]},{"description":"Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow ","code_information":[{"code":"L6638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2920.89,"maximum":3129.53,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2980.50,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2980.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2980.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2980.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2980.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2980.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2980.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2980.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2980.50,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3129.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2980.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2950.70,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3040.11,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2980.50,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2980.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2980.50,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2980.50,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2980.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2920.89,"methodology":"fee schedule"}]}]},{"description":"Valproic acid (dipropylacetic acid); total ","code_information":[{"code":"80164","type":"CPT"},{"code":"903212","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":13.27,"maximum":57.42,"gross_charge":146.15,"discounted_cash":146.15,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":55.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":13.27,"methodology":"fee schedule"}]}]},{"description":"Wheelchair accessory, ventilator tray, gimbaled ","code_information":[{"code":"E1030","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":134.30,"maximum":143.89,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":143.89,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":135.67,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":139.78,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":137.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":134.30,"methodology":"fee schedule"}]}]},{"description":"Acetylcholine receptor (AChR); binding antibody ","code_information":[{"code":"86041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.03,"maximum":19.32,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":18.22,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18.03,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity fracture orthosis, adjustable motion knee joint, lerman type ","code_information":[{"code":"L2186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":194.36,"maximum":208.25,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":208.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":196.35,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":202.30,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":194.36,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, below knee, waist belt, webbing ","code_information":[{"code":"L5688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":70.17,"maximum":75.18,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":75.18,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":70.88,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":73.03,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":71.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":70.17,"methodology":"fee schedule"}]}]},{"description":"Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system ","code_information":[{"code":"L5781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4673.42,"maximum":5007.24,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4768.80,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4768.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4768.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4768.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4768.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4768.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4768.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4768.80,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4768.80,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5007.24,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4768.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4721.11,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4864.18,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4768.80,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4768.80,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4768.80,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4768.80,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4768.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4673.42,"methodology":"fee schedule"}]}]},{"description":"Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal) ","code_information":[{"code":"L7400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":357.99,"maximum":383.57,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":365.30,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":365.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":365.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":365.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":365.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":365.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":365.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":365.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":365.30,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":383.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":365.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":361.65,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":372.61,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":365.30,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":365.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":365.30,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":365.30,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":365.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":357.99,"methodology":"fee schedule"}]}]},{"description":"Addition, exoskeletal knee-shin system, single axis, manual lock ","code_information":[{"code":"L5710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":487.49,"maximum":522.31,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":497.44,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":497.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":497.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":497.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":497.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":497.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":497.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":497.44,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":497.44,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":522.31,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":497.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":492.47,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":507.39,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":497.44,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":497.44,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":497.44,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":497.44,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":497.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":487.49,"methodology":"fee schedule"}]}]},{"description":"Amputee wheelchair, detachable arms (desk or full length) without footrests or legrest ","code_information":[{"code":"E1172","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":126.20,"maximum":135.22,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":128.78,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":128.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":128.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":128.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":128.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":128.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":128.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":128.78,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":128.78,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":135.22,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":128.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":127.49,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":131.36,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":128.78,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":128.78,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":128.78,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":128.78,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":128.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":126.20,"methodology":"fee schedule"}]}]},{"description":"Ankle orthosis, ankle gauntlet or similar, with or without joints, custom fabricated ","code_information":[{"code":"L1904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":507.00,"maximum":543.22,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":517.35,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":517.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":517.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":517.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":517.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":517.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":517.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":517.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":517.35,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":543.22,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":517.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":512.18,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":527.70,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":517.35,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":517.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":517.35,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":517.35,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":517.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":507.00,"methodology":"fee schedule"}]}]},{"description":"Antihuman globulin test (Coombs test); indirect, each antibody titer ","code_information":[{"code":"86886","type":"CPT"},{"code":"888595","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.08,"maximum":255.42,"gross_charge":694.38,"discounted_cash":694.38,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":245.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.08,"methodology":"fee schedule"}]}]},{"description":"Auditory osseointegrated device, transducer/actuator, replacement only, each ","code_information":[{"code":"L8694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1105.28,"maximum":1184.23,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1127.84,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1127.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1127.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1127.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1127.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1127.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1127.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1127.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1127.84,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1184.23,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1127.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1116.56,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1150.40,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1127.84,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1127.84,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1127.84,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1127.84,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1127.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1105.28,"methodology":"fee schedule"}]}]},{"description":"Below elbow, molded socket, flexible elbow hinge, triceps pad ","code_information":[{"code":"L6100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2324.25,"maximum":2490.26,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2371.68,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2371.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2371.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2371.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2371.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2371.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2371.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2371.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2371.68,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2490.26,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2371.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2347.96,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2419.11,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2371.68,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2371.68,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2371.68,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2371.68,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2371.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2324.25,"methodology":"fee schedule"}]}]},{"description":"C-reactive protein; ","code_information":[{"code":"86140","type":"CPT"},{"code":"902571","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.08,"maximum":15.84,"gross_charge":372.87,"discounted_cash":372.87,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":15.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.08,"methodology":"fee schedule"}]}]},{"description":"Cast supplies, long arm cast, adult (11 years +), plaster ","code_information":[{"code":"Q4005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":15.49,"maximum":16.60,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":16.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":15.65,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16.13,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":15.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15.49,"methodology":"fee schedule"}]}]},{"description":"Cervical traction equipment not requiring additional stand or frame ","code_information":[{"code":"E0855","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":67.21,"maximum":72.01,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":68.58,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":68.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":68.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":68.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":68.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":68.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":68.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":68.58,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":68.58,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":72.01,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":68.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":67.89,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":69.95,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":68.58,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":68.58,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":68.58,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":68.58,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":68.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":67.21,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; protein S, total ","code_information":[{"code":"85305","type":"CPT"},{"code":"903366","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.38,"maximum":33.66,"gross_charge":802.35,"discounted_cash":802.35,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.19,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.49,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":11.84,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":32.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":11.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.38,"methodology":"fee schedule"}]}]},{"description":"Complement; total hemolytic (CH50) ","code_information":[{"code":"86162","type":"CPT"},{"code":"902725","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":19.91,"maximum":22.77,"gross_charge":104.82,"discounted_cash":104.82,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":21.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":20.12,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":20.73,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":20.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19.91,"methodology":"fee schedule"}]}]},{"description":"Culture, bacterial; quantitative, aerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool ","code_information":[{"code":"87071","type":"CPT"},{"code":"947210","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":9.69,"maximum":28.71,"gross_charge":542.32,"discounted_cash":542.32,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9.79,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":10.09,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":28.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":28.71,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":27.55,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":9.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9.69,"methodology":"fee schedule"}]}]},{"description":"CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, targeted sequence analysis (ie, CYP2D7-2D6 hybrid gene) (List separately in addition to code for pri ","code_information":[{"code":"0073U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":441.89,"maximum":1289.97,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":473.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":446.40,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":459.93,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1289.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1289.97,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1237.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":450.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":441.89,"methodology":"fee schedule"}]}]},{"description":"Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay ºeg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA»), c ","code_information":[{"code":"80307","type":"CPT"},{"code":"892638","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":60.90,"maximum":77.22,"gross_charge":575.40,"discounted_cash":575.40,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":65.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":61.52,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":63.38,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":77.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":77.22,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":74.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":62.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":60.90,"methodology":"fee schedule"}]}]},{"description":"Elevating legrest, lower extension tube, replacement only, each ","code_information":[{"code":"K0046","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":22.37,"maximum":23.97,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":23.97,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22.60,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":23.29,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22.37,"methodology":"fee schedule"}]}]},{"description":"Fat or lipids, feces; qualitative ","code_information":[{"code":"82705","type":"CPT"},{"code":"902863","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.00,"maximum":71.28,"gross_charge":340.04,"discounted_cash":340.04,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":68.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.00,"methodology":"fee schedule"}]}]},{"description":"Fibrinolytic factors and inhibitors; plasmin ","code_information":[{"code":"85400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.56,"maximum":27.72,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":8.10,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7.63,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":7.86,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26.60,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":7.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7.56,"methodology":"fee schedule"}]}]},{"description":"Footrest, lower extension tube, replacement only, each ","code_information":[{"code":"K0043","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":22.23,"maximum":23.81,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":23.81,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22.45,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":23.13,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22.23,"methodology":"fee schedule"}]}]},{"description":"Gentamicin ","code_information":[{"code":"80170","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.05,"maximum":38.61,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.22,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16.71,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16.05,"methodology":"fee schedule"}]}]},{"description":"Gradient compression bandaging supply, bandage liner, lower extremity, any size or length, each ","code_information":[{"code":"A6594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":32.48,"maximum":34.80,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":34.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":32.81,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":33.80,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":33.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":32.48,"methodology":"fee schedule"}]}]},{"description":"Gradient compression stocking, waist length, 40 mmhg or greater, custom, each ","code_information":[{"code":"A6564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1013.32,"maximum":1085.70,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1034.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1034.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1034.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1034.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1034.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1034.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1034.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1034.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1034.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1085.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1034.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1023.66,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1054.68,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1034.00,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1034.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1034.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1034.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1034.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1013.32,"methodology":"fee schedule"}]}]},{"description":"Hematology (congenital neutropenia), genomic sequence analysis of 23 genes, blood, buccal swab, or amniotic fluid ","code_information":[{"code":"0271U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":596.01,"maximum":638.58,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":638.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":602.09,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":620.33,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":608.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":596.01,"methodology":"fee schedule"}]}]},{"description":"Hemosiderin, qualitative ","code_information":[{"code":"83070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.66,"maximum":24.75,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":23.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.66,"methodology":"fee schedule"}]}]},{"description":"Hip orthosis, abduction control of hip joints, static, adjustable, (ilfled type), prefabricated, includes fitting and adjustment ","code_information":[{"code":"L1650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":281.30,"maximum":301.39,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":301.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":284.17,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":292.78,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":287.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":281.30,"methodology":"fee schedule"}]}]},{"description":"Hospital bed, extra heavy duty, extra wide, with weight capacity greater than 600 pounds, with any type side rails, with mattress ","code_information":[{"code":"E0304","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":551.12,"maximum":590.49,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":562.37,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":562.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":562.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":562.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":562.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":562.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":562.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":562.37,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":562.37,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":590.49,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":562.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":556.75,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":573.62,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":562.37,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":562.37,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":562.37,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":562.37,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":562.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":551.12,"methodology":"fee schedule"}]}]},{"description":"Hydrocolloid dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing ","code_information":[{"code":"A6236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":36.44,"maximum":39.04,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":39.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":36.81,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":37.92,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":37.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":36.44,"methodology":"fee schedule"}]}]},{"description":"Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement ","code_information":[{"code":"E0785","type":"HCPCS"}],"standard_charges":[{"modifiers":"KF","modifiers_description":"Item designated by FDA as Class III device","setting":"outpatient","minimum":631.83,"maximum":676.96,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":644.72,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":644.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":644.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":644.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":644.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":644.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":644.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":644.72,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":644.72,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":676.96,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":644.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":638.27,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":657.61,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":644.72,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":644.72,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":644.72,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":644.72,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":644.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":631.83,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; not otherwise specified ","code_information":[{"code":"87899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.75,"maximum":61.38,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":15.91,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16.39,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":61.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":61.38,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":58.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15.75,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Candida species, quantification ","code_information":[{"code":"87482","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54.15,"maximum":58.53,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":58.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":55.18,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":56.85,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":56.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":56.43,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":55.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":54.63,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, quantification ","code_information":[{"code":"87652","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":40.92,"maximum":99.99,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":43.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":41.34,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":42.60,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":95.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":41.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":40.92,"methodology":"fee schedule"}]}]},{"description":"Insulin tolerance panel; for ACTH insufficiency This panel must include the following: Cortisol (82533 x 5) Glucose (82947 x 5) ","code_information":[{"code":"80434","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":279.33,"maximum":423.72,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":285.03,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":285.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":285.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":285.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":285.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":285.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":285.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":285.03,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":285.03,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":299.28,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":285.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":282.18,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":290.73,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":285.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":423.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":423.72,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":285.03,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":406.60,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":285.03,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":285.03,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":285.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":279.33,"methodology":"fee schedule"}]}]},{"description":"Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, cu ","code_information":[{"code":"L1846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1210.12,"maximum":1296.56,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1234.82,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1234.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1234.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1234.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1234.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1234.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1234.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1234.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1234.82,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1296.56,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1234.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1222.47,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1259.52,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1234.82,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1234.82,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1234.82,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1234.82,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1234.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1210.12,"methodology":"fee schedule"}]}]},{"description":"Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsA ","code_information":[{"code":"80074","type":"CPT"},{"code":"903079","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":28.50,"maximum":50.01,"gross_charge":844.14,"discounted_cash":844.14,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":50.01,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":47.15,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":48.58,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":29.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":29.70,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":28.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":47.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":46.68,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity prosthesis, user adjustable heel height ","code_information":[{"code":"L5990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2119.00,"maximum":2270.35,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2162.24,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2162.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2162.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2162.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2162.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2162.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2162.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2162.24,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2162.24,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2270.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2162.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2140.62,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2205.48,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2162.24,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2162.24,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2162.24,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2162.24,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2162.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2119.00,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, pelvic control, hip joint, heavy duty, each ","code_information":[{"code":"L2620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":288.28,"maximum":308.87,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":308.87,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":291.22,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":300.04,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":294.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":288.28,"methodology":"fee schedule"}]}]},{"description":"Addition to tlso, (low profile), anterior thoracic extension ","code_information":[{"code":"L1220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":249.05,"maximum":266.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":254.13,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":254.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":254.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":254.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":254.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":254.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":254.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":254.13,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":254.13,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":266.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":254.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":251.59,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":259.21,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":254.13,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":254.13,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":254.13,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":254.13,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":254.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":249.05,"methodology":"fee schedule"}]}]},{"description":"Addition, exoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) ","code_information":[{"code":"L5790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":825.91,"maximum":884.91,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":842.77,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":842.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":842.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":842.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":842.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":842.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":842.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":842.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":842.77,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":884.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":842.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":834.34,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":859.63,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":842.77,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":842.77,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":842.77,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":842.77,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":842.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":825.91,"methodology":"fee schedule"}]}]},{"description":"Alpha-fetoprotein (AFP); AFP-L3 fraction isoform and total AFP (including ratio) ","code_information":[{"code":"82107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":36.10,"maximum":67.63,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":67.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":63.77,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":65.70,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":37.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":37.62,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":36.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":64.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":63.12,"methodology":"fee schedule"}]}]},{"description":"Antibody; Bordetella ","code_information":[{"code":"86615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.93,"maximum":42.57,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13.06,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.45,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":13.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.93,"methodology":"fee schedule"}]}]},{"description":"Antibody; helminth, not elsewhere specified ","code_information":[{"code":"86682","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.75,"maximum":39.60,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.66,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.27,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":39.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":39.60,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":38.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":13.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.75,"methodology":"fee schedule"}]}]},{"description":"Aquaporin-4 (neuromyelitis optica ºNMO») antibody; enzyme-linked immunosorbent immunoassay (ELISA) ","code_information":[{"code":"86051","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.30,"maximum":33.66,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.41,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":11.76,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":32.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":11.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.30,"methodology":"fee schedule"}]}]},{"description":"Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device ","code_information":[{"code":"L6935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10511.77,"maximum":11262.61,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":10726.30,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":10726.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":10726.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":10726.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":10726.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":10726.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":10726.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":10726.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":10726.30,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":11262.61,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":10726.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":10619.04,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":10940.83,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":10726.30,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":10726.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":10726.30,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":10726.30,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":10726.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10511.77,"methodology":"fee schedule"}]}]},{"description":"Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type ","code_information":[{"code":"L8002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":192.71,"maximum":206.47,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":196.64,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":196.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":196.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":196.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":196.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":196.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":196.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":196.64,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":196.64,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":206.47,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":196.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":194.67,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":200.57,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":196.64,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":196.64,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":196.64,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":196.64,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":196.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":192.71,"methodology":"fee schedule"}]}]},{"description":"Canister, non-disposable, used with suction pump, each ","code_information":[{"code":"A7001","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":39.66,"maximum":42.49,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":42.49,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":40.07,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":41.28,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":39.66,"methodology":"fee schedule"}]}]},{"description":"Cast supplies, short leg splint, adult (11 years +), plaster ","code_information":[{"code":"Q4045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":13.88,"maximum":14.87,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":14.87,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14.02,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":14.44,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":14.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":13.88,"methodology":"fee schedule"}]}]},{"description":"Chromosome analysis for breakage syndromes; baseline breakage, score 50-100 cells, count 20 cells, 2 karyotypes (eg, for ataxia telangiectasia, Fanconi anemia, fragile X) ","code_information":[{"code":"88248","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":169.71,"maximum":421.74,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":181.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":171.44,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":176.63,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":421.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":421.74,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":404.70,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":173.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":169.71,"methodology":"fee schedule"}]}]},{"description":"Commode chair, mobile or stationary, with detachable arms ","code_information":[{"code":"E0165","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":14.80,"maximum":15.86,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":15.86,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14.95,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":15.40,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":15.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14.80,"methodology":"fee schedule"}]}]},{"description":"Crutch forearm, includes crutches of various materials, adjustable or fixed, each, with tip and handgrips ","code_information":[{"code":"E0111","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":68.84,"maximum":73.75,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":73.75,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":69.54,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":71.64,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":70.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":68.84,"methodology":"fee schedule"}]}]},{"description":"Culture, typing; other methods ","code_information":[{"code":"87158","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.59,"maximum":99.99,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":8.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7.66,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":7.89,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":95.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":7.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7.59,"methodology":"fee schedule"}]}]},{"description":"Drug metabolism (eg, pharmacogenomics) genomic sequence analysis panel, must include testing of at least 6 genes, including CYP2C19, CYP2D6, and CYP2D6 duplication/deletion analysis ","code_information":[{"code":"81418","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":898.74,"maximum":962.93,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":917.08,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":917.08,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":917.08,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":917.08,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":917.08,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":917.08,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":917.08,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":917.08,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":917.08,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":962.93,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":917.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":907.91,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":935.42,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":917.08,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":917.08,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":917.08,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":917.08,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":917.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":898.74,"methodology":"fee schedule"}]}]},{"description":"Electronic elbow, child, variety village or equal, switch controlled ","code_information":[{"code":"L7186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":13288.11,"maximum":14237.26,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":13559.30,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":13559.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":13559.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":13559.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":13559.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":13559.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":13559.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":13559.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":13559.30,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":14237.26,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":13559.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13423.71,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13830.49,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":13559.30,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":13559.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":13559.30,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":13559.30,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":13559.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":13288.11,"methodology":"fee schedule"}]}]},{"description":"Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody ","code_information":[{"code":"86235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.57,"maximum":37.62,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":17.75,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":18.29,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":37.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":37.62,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":36.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":17.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":17.57,"methodology":"fee schedule"}]}]},{"description":"Fibrin(ogen) degradation (split) products (FDP) (FSP); quantitative ","code_information":[{"code":"85370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.40,"maximum":13.05,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12.31,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.68,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":11.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":12.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.18,"methodology":"fee schedule"}]}]},{"description":"Foot, abduction rotation bar, including shoes ","code_information":[{"code":"L3140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":103.78,"maximum":111.20,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":105.90,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":105.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":105.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":105.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":105.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":105.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":105.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":105.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":105.90,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":111.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":105.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":104.84,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":108.02,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":105.90,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":105.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":105.90,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":105.90,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":105.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":103.78,"methodology":"fee schedule"}]}]},{"description":"Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing ","code_information":[{"code":"A6224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4.81,"maximum":5.16,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.86,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.01,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.81,"methodology":"fee schedule"}]}]},{"description":"Gradient compression bandage roll, elastic medium stretch, per linear yard, any width, each ","code_information":[{"code":"A6598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":0.70,"maximum":0.75,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":0.75,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":0.70,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":0.72,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":0.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":0.70,"methodology":"fee schedule"}]}]},{"description":"Hand restoration (casts, shading and measurements included), partial hand, with glove, multiple fingers remaining ","code_information":[{"code":"L6905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1686.49,"maximum":1806.96,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1806.96,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1703.70,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1755.33,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1720.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1686.49,"methodology":"fee schedule"}]}]},{"description":"Heel, sach cushion type ","code_information":[{"code":"L3450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":123.02,"maximum":131.81,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":131.81,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":124.27,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":128.04,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":125.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":123.02,"methodology":"fee schedule"}]}]},{"description":"Hemipelvectomy, canadian type; molded socket, hip joint, single axis constant friction knee, shin, sach foot ","code_information":[{"code":"L5280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7757.06,"maximum":8311.14,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":7915.37,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":7915.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":7915.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":7915.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":7915.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":7915.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":7915.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":7915.37,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":7915.37,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":8311.14,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":7915.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7836.22,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":8073.68,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":7915.37,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":7915.37,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":7915.37,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":7915.37,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":7915.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7757.06,"methodology":"fee schedule"}]}]},{"description":"Hereditary neuroendocrine tumor-related disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma), genomic sequence analysis panel, 5 or more gene ","code_information":[{"code":"81437","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":430.15,"maximum":1255.32,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":460.88,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":434.54,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":447.71,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1255.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1255.32,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1204.60,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":438.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":430.15,"methodology":"fee schedule"}]}]},{"description":"Homogenization, tissue, for culture ","code_information":[{"code":"87176","type":"CPT"},{"code":"942013","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.76,"maximum":31.68,"gross_charge":40.36,"discounted_cash":40.36,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":6.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":31.68,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":30.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.76,"methodology":"fee schedule"}]}]},{"description":"Immunoassay for infectious agent antibody, quantitative, not otherwise specified ","code_information":[{"code":"86317","type":"CPT"},{"code":"946353","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":13.30,"maximum":15.74,"gross_charge":227.78,"discounted_cash":227.78,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":15.74,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14.84,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":15.29,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":14.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14.69,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Neisseria gonorrhoeae ","code_information":[{"code":"87850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24.07,"maximum":36.63,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":24.31,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":25.05,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":24.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":24.07,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, amplified probe technique, includes reverse transcription when performed ","code_information":[{"code":"87521","type":"CPT"},{"code":"903179","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":34.39,"maximum":118.80,"gross_charge":1707.86,"discounted_cash":1707.86,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":118.80,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":118.80,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":114.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":34.39,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique ","code_information":[{"code":"87591","type":"CPT"},{"code":"903349","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":34.39,"maximum":56.43,"gross_charge":322.15,"discounted_cash":322.15,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":56.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":56.43,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":34.39,"methodology":"fee schedule"}]}]},{"description":"Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; each additional drug tested (List separately in addition to code for primary proce ","code_information":[{"code":"87904","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25.55,"maximum":372.24,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":27.37,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":25.81,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":26.59,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":372.24,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":372.24,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":357.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":26.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":25.55,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type ","code_information":[{"code":"L5856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28019.28,"maximum":30020.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":28591.10,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":28591.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":28591.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":28591.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":28591.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":28591.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":28591.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":28591.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":28591.10,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":30020.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":28591.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":28305.19,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":29162.92,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":28591.10,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":28591.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":28591.10,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":28591.10,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":28591.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":28019.28,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables ","code_information":[{"code":"L2628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2408.50,"maximum":2580.53,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2457.65,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2457.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2457.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2457.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2457.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2457.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2457.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2457.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2457.65,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2580.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2457.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2433.07,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2506.80,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2457.65,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2457.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2457.65,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2457.65,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2457.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2408.50,"methodology":"fee schedule"}]}]},{"description":"Addition to tlso, (low profile), anterior asis pad ","code_information":[{"code":"L1250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":77.89,"maximum":83.45,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":83.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":78.69,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":81.07,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":79.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":77.89,"methodology":"fee schedule"}]}]},{"description":"Adhesive or non-adhesive; disk or foam pad ","code_information":[{"code":"A5126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1.75,"maximum":1.88,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1.88,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1.77,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1.83,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1.75,"methodology":"fee schedule"}]}]},{"description":"All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal) ","code_information":[{"code":"L5986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":970.52,"maximum":1039.85,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":990.33,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":990.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":990.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":990.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":990.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":990.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":990.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":990.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":990.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1039.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":990.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":980.43,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1010.14,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":990.33,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":990.33,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":990.33,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":990.33,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":990.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":970.52,"methodology":"fee schedule"}]}]},{"description":"Ammonia ","code_information":[{"code":"82140","type":"CPT"},{"code":"902482","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":14.28,"maximum":65.34,"gross_charge":259.50,"discounted_cash":259.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14.42,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":14.86,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":65.34,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":62.70,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":14.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14.28,"methodology":"fee schedule"}]}]},{"description":"Antibody; adenovirus ","code_information":[{"code":"86603","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.40,"maximum":13.51,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":11.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.61,"methodology":"fee schedule"}]}]},{"description":"Antibody; respiratory syncytial virus ","code_information":[{"code":"86756","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.57,"maximum":45.54,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":15.73,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16.21,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":45.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":45.54,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":15.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15.57,"methodology":"fee schedule"}]}]},{"description":"AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; known familial variant ","code_information":[{"code":"81174","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":181.50,"maximum":858.33,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":194.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":183.35,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":858.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":858.33,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":823.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":181.50,"methodology":"fee schedule"}]}]},{"description":"Bile acids; total ","code_information":[{"code":"82239","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.78,"maximum":53.46,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.95,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":17.46,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":53.46,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":51.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16.78,"methodology":"fee schedule"}]}]},{"description":"Calcium; total ","code_information":[{"code":"82310","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.06,"maximum":13.86,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.42,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.11,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.26,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.06,"methodology":"fee schedule"}]}]},{"description":"Cast supplies, long leg splint, pediatric (0-10 years), plaster ","code_information":[{"code":"Q4043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":11.96,"maximum":12.81,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":12.20,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":12.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":12.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":12.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":12.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":12.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":12.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":12.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":12.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.81,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":12.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":12.20,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":12.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":12.20,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":12.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":12.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.96,"methodology":"fee schedule"}]}]},{"description":"Chimerism (engraftment) analysis, post transplantation specimen (eg, hematopoietic stem cell), includes comparison to previously performed baseline analyses; with cell selection (eg, CD3, CD33), each ","code_information":[{"code":"81268","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":255.57,"maximum":494.01,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":273.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":258.18,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":266.01,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":494.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":494.01,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":474.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":260.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":255.57,"methodology":"fee schedule"}]}]},{"description":"Cochlear device, includes all internal and external components ","code_information":[{"code":"L8614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22301.08,"maximum":23894.01,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22756.20,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":22756.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":22756.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":22756.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":22756.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":22756.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":22756.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":22756.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22756.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":23894.01,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22756.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22528.64,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":23211.32,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":22756.20,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22756.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":22756.20,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":22756.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22756.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22301.08,"methodology":"fee schedule"}]}]},{"description":"Complement; functional activity, each component ","code_information":[{"code":"86161","type":"CPT"},{"code":"947029","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.76,"maximum":45.54,"gross_charge":334.09,"discounted_cash":334.09,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.24,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":45.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":45.54,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":12.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.76,"methodology":"fee schedule"}]}]},{"description":"Cortisol; total ","code_information":[{"code":"82533","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.97,"maximum":52.47,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.14,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16.63,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15.97,"methodology":"fee schedule"}]}]},{"description":"Cytog Const Alys Interrog Gen Reg F/Copy Number ","code_information":[{"code":"0209U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":771.41,"maximum":2251.26,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":826.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":779.28,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":802.89,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2251.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2251.26,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2160.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":787.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":771.41,"methodology":"fee schedule"}]}]},{"description":"Drug test(s), definitive, 90 or more drugs or substances, definitive chromatography with mass spectrometry, and presumptive, any number of drug classes, by instrument chemistry analyzer (utilizing imm ","code_information":[{"code":"0082U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":241.98,"maximum":705.87,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":259.27,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":244.45,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":251.86,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":705.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":705.87,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":677.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":246.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":241.98,"methodology":"fee schedule"}]}]},{"description":"Electronic elbow, hosmer or equal, switch controlled ","code_information":[{"code":"L7170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7066.87,"maximum":7571.64,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":7211.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":7211.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":7211.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":7211.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":7211.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":7211.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":7211.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":7211.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":7211.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":7571.64,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":7211.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7138.98,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":7355.31,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":7211.09,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":7211.09,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":7211.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":7211.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":7211.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7066.87,"methodology":"fee schedule"}]}]},{"description":"Ethylene glycol ","code_information":[{"code":"82693","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.60,"maximum":61.38,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":15.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":15.20,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":61.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":61.38,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":58.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":14.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14.60,"methodology":"fee schedule"}]}]},{"description":"Foot, arch support, non-removable attached to shoe, longitudinal, each ","code_information":[{"code":"L3070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":37.06,"maximum":39.71,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":37.82,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":37.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":37.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":37.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":37.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":37.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":37.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":37.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":37.82,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":39.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":37.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":37.44,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":38.58,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":37.82,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":37.82,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":37.82,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":37.82,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":37.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":37.06,"methodology":"fee schedule"}]}]},{"description":"Lift, elevation, heel, tapered to metatarsals, per inch ","code_information":[{"code":"L3300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":60.79,"maximum":65.13,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":62.03,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":62.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":62.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":62.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":62.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":62.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":62.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":62.03,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":62.03,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":65.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":62.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":61.41,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":63.27,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":62.03,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":62.03,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":62.03,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":62.03,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":62.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":60.79,"methodology":"fee schedule"}]}]},{"description":"Liver disease, ten biochemical assays (ALT, A2-macroglobulin, apolipoprotein A-1, total bilirubin, GGT, haptoglobin, AST, glucose, total cholesterol and triglycerides) utilizing serum, prognostic algo ","code_information":[{"code":"0002M","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":493.33,"maximum":1439.46,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":528.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":498.37,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":513.47,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1439.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1439.46,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1381.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":493.33,"methodology":"fee schedule"}]}]},{"description":"Metatarsal joint implant ","code_information":[{"code":"L8641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":536.12,"maximum":574.41,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":547.06,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":547.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":547.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":547.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":547.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":547.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":547.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":547.06,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":547.06,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":574.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":547.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":541.59,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":558.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":547.06,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":547.06,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":547.06,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":547.06,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":547.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":536.12,"methodology":"fee schedule"}]}]},{"description":"MSH6 (mutS homolog 6 ºE. coli») (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants ","code_information":[{"code":"81299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":301.84,"maximum":1091.97,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":323.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":304.92,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":314.16,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1091.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1091.97,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1047.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":308.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":301.84,"methodology":"fee schedule"}]}]},{"description":"Neutralization test, viral ","code_information":[{"code":"86382","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.57,"maximum":32.67,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.76,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":17.25,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":32.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":32.67,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":31.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16.57,"methodology":"fee schedule"}]}]},{"description":"Oncology (ovarian) biochemical assays of five proteins (apolipoprotein A-1, CA 125 II, follicle stimulating hormone, human epididymis protein 4, transferrin), utilizing serum, algorithm reported as a ","code_information":[{"code":"0003U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":931.00,"maximum":2717.55,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":997.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":940.50,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":969.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2717.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2717.55,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2607.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":950.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":931.00,"methodology":"fee schedule"}]}]},{"description":"Oncology, prostate cancer, mRNA expression assay of 12 genes (10 content and 2 housekeeping), RT-PCR test utilizing blood plasma and urine, algorithms to predict high-grade prostate cancer risk ","code_information":[{"code":"0011M","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":744.80,"maximum":2174.04,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":752.40,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2174.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2174.04,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2086.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":744.80,"methodology":"fee schedule"}]}]},{"description":"Ostomy clamp, any type, replacement only, each ","code_information":[{"code":"A4363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3.17,"maximum":3.39,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3.20,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3.29,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3.23,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3.17,"methodology":"fee schedule"}]}]},{"description":"Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each ","code_information":[{"code":"A4432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4.79,"maximum":5.13,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.79,"methodology":"fee schedule"}]}]},{"description":"Phenytoin; total ","code_information":[{"code":"80185","type":"CPT"},{"code":"903215","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.98,"maximum":51.48,"gross_charge":429.52,"discounted_cash":429.52,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":49.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.98,"methodology":"fee schedule"}]}]},{"description":"Power operated vehicle, group 1 heavy duty, patient weight capacity 301 to 450 pounds ","code_information":[{"code":"K0801","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":1763.30,"maximum":1889.25,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1799.29,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1799.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1799.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1799.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1799.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1799.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1799.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1799.29,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1799.29,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1889.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1799.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1781.30,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1835.28,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1799.29,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1799.29,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1799.29,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1799.29,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1799.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1763.30,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair, group 2 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds ","code_information":[{"code":"K0841","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":469.13,"maximum":502.63,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":478.70,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":478.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":478.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":478.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":478.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":478.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":478.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":478.70,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":478.70,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":502.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":478.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":473.91,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":488.27,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":478.70,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":478.70,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":478.70,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":478.70,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":478.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":469.13,"methodology":"fee schedule"}]}]},{"description":"Proinsulin ","code_information":[{"code":"84206","type":"CPT"},{"code":"902741","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":26.16,"maximum":48.51,"gross_charge":441.47,"discounted_cash":441.47,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":28.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":26.42,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":27.22,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":48.51,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":46.55,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":26.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":26.16,"methodology":"fee schedule"}]}]},{"description":"Red blood cell antigen typing, DNA, genotyping of at least 16 blood groups with phenotype prediction of at least 51 red blood cell antigens ","code_information":[{"code":"0246U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":705.60,"maximum":2059.20,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":756.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":712.80,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":734.40,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2059.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2059.20,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1976.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":705.60,"methodology":"fee schedule"}]}]},{"description":"Replacement diaphragm/faceplate for tracheostoma valve, each ","code_information":[{"code":"A7502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":66.76,"maximum":71.53,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":71.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":67.44,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":69.48,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":68.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":66.76,"methodology":"fee schedule"}]}]},{"description":"Segmental pneumatic appliance for use with pneumatic compressor, full leg ","code_information":[{"code":"E0667","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":367.99,"maximum":394.28,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":375.50,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":375.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":375.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":375.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":375.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":375.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":375.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":375.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":375.50,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":394.28,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":375.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":371.75,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":383.01,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":375.50,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":375.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":375.50,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":375.50,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":375.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":367.99,"methodology":"fee schedule"}]}]},{"description":"Sialic acid ","code_information":[{"code":"84275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.17,"maximum":57.42,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":14.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13.31,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.71,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":55.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":13.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":13.17,"methodology":"fee schedule"}]}]},{"description":"Speech generating device, synthesized speech, requiring message formulation by spelling and access by physical contact with the device ","code_information":[{"code":"E2508","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":4782.49,"maximum":5124.09,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4880.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4880.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4880.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4880.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4880.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4880.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4880.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4880.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4880.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5124.09,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4880.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4831.29,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4977.69,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4880.09,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4880.09,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4880.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4880.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4880.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4782.49,"methodology":"fee schedule"}]}]},{"description":"Static progressive stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories ","code_information":[{"code":"E1801","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":172.51,"maximum":184.83,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":176.03,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":176.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":176.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":176.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":176.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":176.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":176.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":176.03,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":176.03,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":184.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":176.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":174.27,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":179.55,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":176.03,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":176.03,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":176.03,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":176.03,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":176.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":172.51,"methodology":"fee schedule"}]}]},{"description":"Terminal device, hook or hand, heavy duty, mechanical, voluntary closing, any material, any size, lined or unlined ","code_information":[{"code":"L6722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2368.25,"maximum":2537.41,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2416.58,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2416.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2416.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2416.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2416.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2416.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2416.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2416.58,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2416.58,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2537.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2416.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2392.41,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2464.91,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2416.58,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2416.58,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2416.58,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2416.58,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2416.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2368.25,"methodology":"fee schedule"}]}]},{"description":"Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type ","code_information":[{"code":"L8509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":127.54,"maximum":136.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":130.14,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":130.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":130.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":130.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":130.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":130.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":130.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":130.14,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":130.14,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":136.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":130.14,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":128.84,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":132.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":130.14,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":130.14,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":130.14,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":130.14,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":130.14,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":127.54,"methodology":"fee schedule"}]}]},{"description":"Upper extremity addition, shoulder joint, multipositional locking, flexion, adjustable abduction friction control, for use with body powered or external powered system ","code_information":[{"code":"L6646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3683.91,"maximum":3947.04,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3759.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3759.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3759.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3759.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3759.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3759.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3759.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3759.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3759.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3947.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3759.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3721.50,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3834.27,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3759.09,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3759.09,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3759.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3759.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3759.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3683.91,"methodology":"fee schedule"}]}]},{"description":"Vancomycin ","code_information":[{"code":"80202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.27,"maximum":39.60,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":14.22,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13.40,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.81,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":39.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":39.60,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":38.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":13.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":13.27,"methodology":"fee schedule"}]}]},{"description":"Water pressure mattress ","code_information":[{"code":"E0187","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":23.56,"maximum":25.24,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25.24,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":23.80,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":24.52,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":24.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":23.56,"methodology":"fee schedule"}]}]},{"description":"Zonisamide ","code_information":[{"code":"80203","type":"CPT"},{"code":"959538","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.98,"maximum":77.22,"gross_charge":400.07,"discounted_cash":400.07,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":77.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":77.22,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":74.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.98,"methodology":"fee schedule"}]}]},{"description":"Addition to ctlso or scoliosis orthosis, kyphosis pad ","code_information":[{"code":"L1020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":93.20,"maximum":99.86,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":95.10,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":95.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":95.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":95.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":95.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":95.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":95.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":95.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":95.10,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":99.86,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":95.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":94.15,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":97.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":95.10,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":95.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":95.10,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":95.10,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":95.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":93.20,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, above knee, flexible inner socket, external frame ","code_information":[{"code":"L5651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1839.27,"maximum":1970.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1876.81,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1876.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1876.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1876.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1876.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1876.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1876.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1876.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1876.81,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1970.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1876.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1858.04,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1914.35,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1876.81,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1876.81,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1876.81,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1876.81,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1876.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1839.27,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, pelvic control, hip joint, clevis type, or thrust bearing, free, each ","code_information":[{"code":"L2600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":240.45,"maximum":257.63,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":245.36,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":245.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":245.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":245.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":245.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":245.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":245.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":245.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":245.36,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":257.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":245.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":242.91,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":250.27,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":245.36,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":245.36,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":245.36,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":245.36,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":245.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":240.45,"methodology":"fee schedule"}]}]},{"description":"Addition to tlso, (low profile), lateral thoracic extension ","code_information":[{"code":"L1210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":376.15,"maximum":403.02,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":383.83,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":383.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":383.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":383.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":383.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":383.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":383.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":383.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":383.83,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":403.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":383.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":379.99,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":391.51,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":383.83,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":383.83,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":383.83,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":383.83,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":383.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":376.15,"methodology":"fee schedule"}]}]},{"description":"Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system ","code_information":[{"code":"L5966","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1545.75,"maximum":1656.16,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1577.30,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1577.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1577.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1577.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1577.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1577.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1577.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1577.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1577.30,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1656.16,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1577.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1561.53,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1608.85,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1577.30,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1577.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1577.30,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1577.30,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1577.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1545.75,"methodology":"fee schedule"}]}]},{"description":"Albumin; serum, plasma or whole blood ","code_information":[{"code":"82040","type":"CPT"},{"code":"902481","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":4.85,"maximum":46.53,"gross_charge":107.40,"discounted_cash":107.40,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.90,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.85,"methodology":"fee schedule"}]}]},{"description":"Ankle, symes, molded socket, sach foot ","code_information":[{"code":"L5050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2859.75,"maximum":3064.02,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2918.11,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2918.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2918.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2918.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2918.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2918.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2918.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2918.11,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2918.11,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3064.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2918.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2888.93,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2976.47,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2918.11,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2918.11,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2918.11,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2918.11,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2918.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2859.75,"methodology":"fee schedule"}]}]},{"description":"Water, distilled, used with large volume nebulizer, 1000 ml ","code_information":[{"code":"A7018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":0.36,"maximum":0.39,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":0.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":0.38,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":0.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":0.36,"methodology":"fee schedule"}]}]},{"description":"Wide heavy duty wheel chair, detachable arms (desk or full length), swing away detachable elevating leg rests ","code_information":[{"code":"E1092","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":146.07,"maximum":156.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":149.05,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":149.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":149.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":149.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":149.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":149.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":149.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":149.05,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":149.05,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":156.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":149.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":147.56,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":152.03,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":149.05,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":149.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":149.05,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":149.05,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":149.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":146.07,"methodology":"fee schedule"}]}]},{"description":"Addition to ctlso or scoliosis orthosis, lumbar sling ","code_information":[{"code":"L1090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":106.75,"maximum":114.38,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":114.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":107.84,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":111.11,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":106.75,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control ","code_information":[{"code":"L5614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1970.99,"maximum":2111.77,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2011.21,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2011.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2011.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2011.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2011.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2011.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2011.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2011.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2011.21,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2111.77,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2011.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1991.10,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2051.43,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2011.21,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2011.21,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2011.21,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2011.21,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2011.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1970.99,"methodology":"fee schedule"}]}]},{"description":"Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated ","code_information":[{"code":"L6895","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":655.56,"maximum":702.39,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":668.94,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":668.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":668.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":668.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":668.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":668.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":668.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":668.94,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":668.94,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":702.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":668.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":662.25,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":682.32,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":668.94,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":668.94,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":668.94,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":668.94,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":668.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":655.56,"methodology":"fee schedule"}]}]},{"description":"Aldosterone suppression evaluation panel (eg, saline infusion) This panel must include the following: Aldosterone (82088 x 2) Renin (84244 x 2) ","code_information":[{"code":"80408","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":122.99,"maximum":177.21,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":125.50,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":125.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":125.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":125.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":125.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":125.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":125.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":125.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":125.50,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":131.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":125.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":124.25,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":128.01,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":125.50,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":177.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":177.21,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":125.50,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":170.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":125.50,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":125.50,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":125.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":122.99,"methodology":"fee schedule"}]}]},{"description":"Amputee wheelchair, detachable arms (desk or full length) swing away detachable footrests ","code_information":[{"code":"E1180","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":122.10,"maximum":130.82,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":124.59,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":124.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":124.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":124.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":124.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":124.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":124.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":124.59,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":124.59,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":130.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":124.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":123.34,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":127.08,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":124.59,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":124.59,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":124.59,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":124.59,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":124.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":122.10,"methodology":"fee schedule"}]}]},{"description":"Antibody identification; platelet associated immunoglobulin assay ","code_information":[{"code":"86023","type":"CPT"},{"code":"902449","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.21,"maximum":50.49,"gross_charge":656.21,"discounted_cash":656.21,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.08,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12.34,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.71,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":50.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":50.49,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":48.45,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":12.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.21,"methodology":"fee schedule"}]}]},{"description":"Antibody; Leptospira ","code_information":[{"code":"86720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.88,"maximum":38.61,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.20,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.01,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.04,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.20,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15.88,"methodology":"fee schedule"}]}]},{"description":"Aqueous shunt ","code_information":[{"code":"L8612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":772.65,"maximum":827.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":788.42,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":788.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":788.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":788.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":788.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":788.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":788.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":788.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":788.42,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":827.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":788.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":780.54,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":804.19,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":788.42,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":788.42,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":788.42,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":788.42,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":788.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":772.65,"methodology":"fee schedule"}]}]},{"description":"Below elbow, external power, self-suspended inner socket, removable forearm shell, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device ","code_information":[{"code":"L6930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9790.91,"maximum":10490.26,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":9990.72,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":9990.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":9990.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":9990.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":9990.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":9990.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":9990.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":9990.72,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":9990.72,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":10490.26,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":9990.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9890.81,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":10190.53,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":9990.72,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":9990.72,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":9990.72,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":9990.72,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":9990.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9790.91,"methodology":"fee schedule"}]}]},{"description":"Blood, occult, by peroxidase activity (eg, guaiac), qualitative; other sources ","code_information":[{"code":"82271","type":"CPT"},{"code":"935756","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.21,"maximum":13.86,"gross_charge":80.53,"discounted_cash":80.53,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.59,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.27,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.43,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.21,"methodology":"fee schedule"}]}]},{"description":"Carbamazepine; free ","code_information":[{"code":"80157","type":"CPT"},{"code":"946798","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.98,"maximum":42.57,"gross_charge":492.16,"discounted_cash":492.16,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.98,"methodology":"fee schedule"}]}]},{"description":"Cast supplies, short arm cast, adult (11 years +), fiberglass ","code_information":[{"code":"Q4010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":23.27,"maximum":24.93,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":24.93,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":23.50,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":24.21,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":23.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":23.27,"methodology":"fee schedule"}]}]},{"description":"Chondroitin B sulfate, quantitative ","code_information":[{"code":"82485","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.15,"maximum":21.68,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":20.44,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":21.06,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":20.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":20.24,"methodology":"fee schedule"}]}]},{"description":"Conductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz ","code_information":[{"code":"A4558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7.29,"maximum":7.81,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":7.81,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":7.59,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":7.44,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7.29,"methodology":"fee schedule"}]}]},{"description":"Culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or isolate, each organism probed ","code_information":[{"code":"87150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.20,"maximum":36.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":15.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":34.39,"methodology":"fee schedule"}]}]},{"description":"Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (eg, maturation index, karyopyknotic index, estrogenic index) (List separately in addition to codeºs» for other technical and ","code_information":[{"code":"88155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.36,"maximum":45.54,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":15.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14.50,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":14.94,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":45.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":45.54,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":14.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14.36,"methodology":"fee schedule"}]}]},{"description":"Dynamic knee, extension/flexion device with active resistance control ","code_information":[{"code":"E1812","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":114.98,"maximum":123.20,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":123.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":116.16,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":119.68,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":117.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":114.98,"methodology":"fee schedule"}]}]},{"description":"Estrone ","code_information":[{"code":"82679","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24.45,"maximum":79.20,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":26.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":24.70,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":79.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":79.20,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":76.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":24.45,"methodology":"fee schedule"}]}]},{"description":"Fat stain, feces, urine, or respiratory secretions ","code_information":[{"code":"89125","type":"CPT"},{"code":"903447","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.76,"maximum":12.87,"gross_charge":146.15,"discounted_cash":146.15,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":6.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.76,"methodology":"fee schedule"}]}]},{"description":"Filter for use in a tracheostoma heat and moisture exchange system, each ","code_information":[{"code":"A7504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":0.91,"maximum":0.98,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":0.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":0.92,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":0.95,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":0.93,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":0.91,"methodology":"fee schedule"}]}]},{"description":"Front caster assembly, complete, with solid tire, replacement only, each ","code_information":[{"code":"K0077","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":65.60,"maximum":70.29,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":66.27,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":68.28,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":66.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":65.60,"methodology":"fee schedule"}]}]},{"description":"Gauze, non-impregnated, sterile, pad size more than 16 sq. in. less than or equal to 48 sq. in., without adhesive border, each dressing ","code_information":[{"code":"A6403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":0.55,"maximum":0.59,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":0.59,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":0.55,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":0.57,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":0.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":0.55,"methodology":"fee schedule"}]}]},{"description":"Gonadotropin releasing hormone stimulation panel This panel must include the following: Follicle stimulating hormone (FSH) (83001 x 4) Luteinizing hormone (LH) (83002 x 4) ","code_information":[{"code":"80426","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":145.44,"maximum":1657.26,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":155.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":146.93,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":151.38,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1657.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1657.26,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1590.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":148.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":145.44,"methodology":"fee schedule"}]}]},{"description":"Gradient compression stocking, waist length, 30-40 mmhg, each ","code_information":[{"code":"A6540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":108.09,"maximum":115.81,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":110.30,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":110.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":110.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":110.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":110.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":110.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":110.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":110.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":110.30,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":115.81,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":110.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":109.20,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":112.51,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":110.30,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":110.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":110.30,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":110.30,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":110.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":108.09,"methodology":"fee schedule"}]}]},{"description":"Heavy duty wheelchair, fixed full length arms, elevating legrest ","code_information":[{"code":"E1295","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":162.42,"maximum":174.02,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":165.73,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":165.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":165.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":165.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":165.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":165.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":165.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":165.73,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":165.73,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":174.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":165.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":164.07,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":169.04,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":165.73,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":165.73,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":165.73,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":165.73,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":165.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":162.42,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin; plasma ","code_information":[{"code":"83051","type":"CPT"},{"code":"903419","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":7.16,"maximum":27.72,"gross_charge":178.97,"discounted_cash":178.97,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":7.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7.24,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":7.46,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26.60,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":7.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7.16,"methodology":"fee schedule"}]}]},{"description":"High frequency chest wall oscillation system, with full anterior and/or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each ","code_information":[{"code":"E0483","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":1421.59,"maximum":1523.13,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1450.60,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1450.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1450.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1450.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1450.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1450.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1450.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1450.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1450.60,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1523.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1450.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1436.09,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1479.61,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1450.60,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1450.60,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1450.60,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1450.60,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1450.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1421.59,"methodology":"fee schedule"}]}]},{"description":"HLA Class I typing, low resolution (eg, antigen equivalents); one antigen equivalent (eg, B*27), each ","code_information":[{"code":"81374","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":72.84,"maximum":1150.38,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":78.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":73.59,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":75.82,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1150.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1150.38,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1103.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":74.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":72.84,"methodology":"fee schedule"}]}]},{"description":"Implantable neurostimulator, pulse generator, any type ","code_information":[{"code":"L8679","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9871.44,"maximum":10576.55,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":10072.90,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":10072.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":10072.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":10072.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":10072.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":10072.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":10072.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":10072.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":10072.90,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":10576.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":10072.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9972.17,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":10274.36,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":10072.90,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":10072.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":10072.90,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":10072.90,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":10072.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9871.44,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay ºEIA», enzyme-linked immunosorbent assay ºELISA», fluorescence immunoassay ºFIA», immunochemiluminometric assay ºIMC ","code_information":[{"code":"87449","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.74,"maximum":33.66,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":32.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.74,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Ehrlichia chaffeensis, amplified probe technique ","code_information":[{"code":"87484","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34.39,"maximum":36.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":34.39,"methodology":"fee schedule"}]}]},{"description":"Insulin-induced C-peptide suppression panel This panel must include the following: Insulin (83525) C-peptide (84681 x 5) Glucose (82947 x 5) ","code_information":[{"code":"80432","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137.75,"maximum":173.89,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":165.61,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":165.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":165.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":165.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":165.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":165.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":165.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":165.61,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":165.61,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":173.89,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":165.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":163.95,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":168.92,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":165.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":143.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":143.55,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":165.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":137.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":165.61,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":165.61,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":165.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":162.30,"methodology":"fee schedule"}]}]},{"description":"Kafo, fracture orthosis, femoral fracture cast orthosis, soft, prefabricated, includes fitting and adjustment ","code_information":[{"code":"L2132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1124.61,"maximum":1204.94,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1147.56,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1147.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1147.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1147.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1147.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1147.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1147.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1147.56,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1147.56,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1204.94,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1147.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1136.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1170.51,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1147.56,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1147.56,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1147.56,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1147.56,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1147.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1124.61,"methodology":"fee schedule"}]}]},{"description":"Knee orthosis, elastic with joints, prefabricated, off-the-shelf ","code_information":[{"code":"L1812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":66.19,"maximum":70.92,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":67.54,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":67.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":67.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":67.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":67.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":67.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":67.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":67.54,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":67.54,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":70.92,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":67.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":66.86,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":68.89,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":67.54,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":67.54,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":67.54,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":67.54,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":67.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":66.19,"methodology":"fee schedule"}]}]},{"description":"Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard ","code_information":[{"code":"A6449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2.34,"maximum":2.51,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2.37,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2.44,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2.34,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, adapter for amputee, each ","code_information":[{"code":"E0959","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":52.89,"maximum":56.67,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":56.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":53.43,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":55.05,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":53.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":52.89,"methodology":"fee schedule"}]}]},{"description":"MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; known familial variant ","code_information":[{"code":"81303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":117.60,"maximum":881.10,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":126.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":118.80,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":122.40,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":881.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":881.10,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":845.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":117.60,"methodology":"fee schedule"}]}]},{"description":"Mucoprotein, blood (seromucoid) (medical necessity procedure) ","code_information":[{"code":"P2038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4.85,"maximum":13.86,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.90,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.05,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.85,"methodology":"fee schedule"}]}]},{"description":"Obstetrics (preterm birth), insulin-like growth factor-binding protein 4 (IBP4), sex hormone-binding globulin (SHBG), quantitative measurement by LC-MS/MS, utilizing maternal serum, combined with clin ","code_information":[{"code":"0247U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":735.00,"maximum":2145.33,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":787.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":742.50,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":765.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2145.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2145.33,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2058.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":750.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":735.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (liver), surveillance for HCC in high-rish patients, analysis of methylation patterns on circulating cfDNA plus measurement of serum of APF/APF-L3 and oncoprotein DCP, algorithm reported as n ","code_information":[{"code":"0333U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":649.07,"maximum":695.44,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":662.32,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":662.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":662.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":662.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":662.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":662.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":662.32,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":662.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":662.32,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":695.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":662.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":655.70,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":675.57,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":662.32,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":662.32,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":662.32,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":662.32,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":662.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":649.07,"methodology":"fee schedule"}]}]},{"description":"Oncology (prostate cancer), analysis of all prostate-specific antigen (psa) structural isoforms by phase separation and immunoassay, plasma, algorithm reports risk of cancer ","code_information":[{"code":"0359U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":744.80,"maximum":798.00,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":752.40,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":744.80,"methodology":"fee schedule"}]}]},{"description":"Oncology, DNA and RNA by nex-gen sequencing, utilizing FFPE tissue, 437 genes, interpretive report for single nucleotide variants, splicesite variants, inserts/deletions, copy number alterations, gene ","code_information":[{"code":"0391U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3528.00,"maximum":3780.00,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3780.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3564.00,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3672.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3528.00,"methodology":"fee schedule"}]}]},{"description":"Ostomy pouch, closed; without barrier attached (1 piece), each ","code_information":[{"code":"A5052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1.99,"maximum":2.13,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2.01,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2.07,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1.99,"methodology":"fee schedule"}]}]},{"description":"Pain management, analysis of 11 endogenous analytes (methymalonic acid, xanthurenic acid, homocysteine, proglutamic acid, vanilmandelate, 5-hydroxyindoleacetic acidm, hydroxymethyglutarate, ethylmalon ","code_information":[{"code":"0117U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":823.84,"maximum":2404.71,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":882.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":832.24,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":857.46,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2404.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2404.71,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2307.55,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":840.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":823.84,"methodology":"fee schedule"}]}]},{"description":"PMS2 (postmeiotic segregation increased 2 ºS. cerevisiae») (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion variants ","code_information":[{"code":"81319","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":199.43,"maximum":593.01,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":203.50,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":203.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":203.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":203.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":203.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":203.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":203.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":203.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":203.50,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":213.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":203.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":201.47,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":207.57,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":203.50,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":593.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":593.01,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":203.50,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":569.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":203.50,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":203.50,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":203.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":199.43,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each ","code_information":[{"code":"E2384","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":73.82,"maximum":79.10,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":79.10,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":74.58,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":76.84,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":75.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":73.82,"methodology":"fee schedule"}]}]},{"description":"Protein, total, except by refractometry; serum, plasma or whole blood ","code_information":[{"code":"84155","type":"CPT"},{"code":"902494","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":3.60,"maximum":118.80,"gross_charge":131.25,"discounted_cash":131.25,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":118.80,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":118.80,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":114.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3.60,"methodology":"fee schedule"}]}]},{"description":"Red cell antigen (MNS blood group) genotyping (GYPA), gene analysis, GYPA (flycophorin A) introns 1, 5, exon 2 ","code_information":[{"code":"0189U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":269.33,"maximum":786.06,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":272.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":786.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":786.06,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":754.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":269.33,"methodology":"fee schedule"}]}]},{"description":"Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pend ","code_information":[{"code":"L0623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":83.40,"maximum":89.36,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":89.36,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":86.80,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":83.40,"methodology":"fee schedule"}]}]},{"description":"Shoulder disarticulation, passive restoration (shoulder cap only) ","code_information":[{"code":"L6320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2092.74,"maximum":2242.22,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2135.45,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2135.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2135.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2135.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2135.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2135.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2135.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2135.45,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2135.45,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2242.22,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2135.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2114.10,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2178.16,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2135.45,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2135.45,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2135.45,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2135.45,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2135.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2092.74,"methodology":"fee schedule"}]}]},{"description":"Smear, primary source with interpretation; complex special stain (eg, trichrome, iron hemotoxylin) for ova and parasites ","code_information":[{"code":"87209","type":"CPT"},{"code":"944856","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":17.62,"maximum":42.57,"gross_charge":16.47,"discounted_cash":16.47,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":18.88,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":17.80,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":18.34,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":42.57,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":40.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":17.62,"methodology":"fee schedule"}]}]},{"description":"Spherocylinder, trifocal, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens ","code_information":[{"code":"V2309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":99.54,"maximum":106.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":101.57,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":101.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":101.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":101.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":101.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":101.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":101.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":101.57,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":101.57,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":106.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":101.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":100.55,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":103.60,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":101.57,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":101.57,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":101.57,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":101.57,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":101.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":99.54,"methodology":"fee schedule"}]}]},{"description":"Susceptibility studies, antimicrobial agent; agar dilution method, per agent (eg, antibiotic gradient strip) ","code_information":[{"code":"87181","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.66,"maximum":11.88,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4.99,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.70,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4.84,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":11.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.66,"methodology":"fee schedule"}]}]},{"description":"Thyrotropin releasing hormone (TRH) stimulation panel; 2 hour This panel must include the following: Thyroid stimulating hormone (TSH) (84443 x 4) ","code_information":[{"code":"80439","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.87,"maximum":814.77,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":70.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":66.54,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":68.55,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":814.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":814.77,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":781.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":67.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":65.87,"methodology":"fee schedule"}]}]},{"description":"Tracheostomy/laryngectomy tube plug/stop, each ","code_information":[{"code":"A7527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4.78,"maximum":5.12,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4.98,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.78,"methodology":"fee schedule"}]}]},{"description":"Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing ","code_information":[{"code":"A6258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5.76,"maximum":6.17,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":6.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.82,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":6.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.76,"methodology":"fee schedule"}]}]},{"description":"Upper extremity addition, lift assist for elbow ","code_information":[{"code":"L6635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":237.94,"maximum":254.94,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":242.80,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":242.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":242.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":242.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":242.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":242.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":242.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":242.80,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":242.80,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":254.94,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":242.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":240.37,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":247.66,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":242.80,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":242.80,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":242.80,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":242.80,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":242.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":237.94,"methodology":"fee schedule"}]}]},{"description":"Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter, each ","code_information":[{"code":"A7048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":57.29,"maximum":61.38,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":61.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":57.88,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":59.63,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":58.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":57.29,"methodology":"fee schedule"}]}]},{"description":"Wheelchair accessory, addition to mobile arm support, offset or lateral rocker arm with elastic balance control ","code_information":[{"code":"E2632","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":196.97,"maximum":211.04,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":211.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":198.98,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":205.01,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":200.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":196.97,"methodology":"fee schedule"}]}]},{"description":"Wheelchair, pediatric size, tilt-in-space, folding, adjustable, without seating system ","code_information":[{"code":"E1234","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":257.94,"maximum":276.36,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":263.20,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":263.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":263.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":263.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":263.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":263.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":263.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":263.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":263.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":276.36,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":263.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":260.57,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":268.46,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":263.20,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":263.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":263.20,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":263.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":263.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":257.94,"methodology":"fee schedule"}]}]},{"description":"Power adapter for pneumatic ventricular assist device, replacement only, vehicle type ","code_information":[{"code":"Q0504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":803.06,"maximum":860.42,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":819.45,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":819.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":819.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":819.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":819.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":819.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":819.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":819.45,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":819.45,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":860.42,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":819.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":811.26,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":835.84,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":819.45,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":819.45,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":819.45,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":819.45,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":819.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":803.06,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, nonstandard seat frame depth, 20 or 21 inches ","code_information":[{"code":"E2342","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":599.03,"maximum":641.82,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":611.26,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":611.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":611.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":611.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":611.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":611.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":611.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":611.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":611.26,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":641.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":611.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":605.15,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":623.49,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":611.26,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":611.26,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":611.26,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":611.26,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":611.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":599.03,"methodology":"fee schedule"}]}]},{"description":"Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, molded to model ","code_information":[{"code":"L5560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2727.85,"maximum":2922.70,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2783.52,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2783.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2783.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2783.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2783.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2783.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2783.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2783.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2783.52,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2922.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2783.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2755.68,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2839.19,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2783.52,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2783.52,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2783.52,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2783.52,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2783.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2727.85,"methodology":"fee schedule"}]}]},{"description":"Protein, total, except by refractometry; urine ","code_information":[{"code":"84156","type":"CPT"},{"code":"902473","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":3.60,"maximum":52.47,"gross_charge":134.24,"discounted_cash":134.24,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3.63,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3.60,"methodology":"fee schedule"}]}]},{"description":"Replace pretibial shell ","code_information":[{"code":"L4130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":614.75,"maximum":658.66,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":627.30,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":627.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":627.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":627.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":627.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":627.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":627.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":627.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":627.30,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":658.66,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":627.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":621.03,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":639.85,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":627.30,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":627.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":627.30,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":627.30,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":627.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":614.75,"methodology":"fee schedule"}]}]},{"description":"Rocking bed with or without side rails ","code_information":[{"code":"E0462","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":345.76,"maximum":370.46,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":370.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":349.29,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":359.88,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":352.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":345.76,"methodology":"fee schedule"}]}]},{"description":"Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease ºCOVID-19») antibody, quantitative ","code_information":[{"code":"86413","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50.40,"maximum":54.00,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":54.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":50.92,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":52.46,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":51.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":50.40,"methodology":"fee schedule"}]}]},{"description":"SMN1 (survival of motor neuton 1, telomeric) and SMN2 (survival of motor neuron 2, centromeric) full gene analysis, including small sequence changes in exonic and intronic regions, duplications and de ","code_information":[{"code":"0236U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":590.65,"maximum":1723.59,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":602.70,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":602.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":602.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":602.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":602.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":602.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":602.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":602.70,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":602.70,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":632.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":602.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":596.67,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":614.75,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":602.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1723.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1723.59,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":602.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1653.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":602.70,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":602.70,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":602.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":590.65,"methodology":"fee schedule"}]}]},{"description":"Sphere, trifocal, plus or minus 4.12 to plus or minus 7.00d, per lens ","code_information":[{"code":"V2301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":88.37,"maximum":94.68,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":94.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":89.27,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":91.97,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":90.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":88.37,"methodology":"fee schedule"}]}]},{"description":"Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00 cylinder, per lens ","code_information":[{"code":"V2305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":94.70,"maximum":101.46,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":101.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":95.66,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":98.56,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":96.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":94.70,"methodology":"fee schedule"}]}]},{"description":"Supplies for maintenance of insulin infusion catheter, per week ","code_information":[{"code":"A4224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":23.97,"maximum":25.68,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":24.22,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":23.97,"methodology":"fee schedule"}]}]},{"description":"Tlso, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine ","code_information":[{"code":"L0482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2133.23,"maximum":2285.61,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2176.77,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2176.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2176.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2176.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2176.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2176.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2176.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2176.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2176.77,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2285.61,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2176.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2155.00,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2220.31,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2176.77,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2176.77,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2176.77,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2176.77,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2176.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2133.23,"methodology":"fee schedule"}]}]},{"description":"Transplantation medicine (allograft rejection, renal), measurement of donor and third-party-induced CD154+T-cytotoxic memory cells, utilizing whole peripheral blood, algorithm reported as a rejection ","code_information":[{"code":"0018M","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":627.92,"maximum":672.77,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":672.77,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":634.32,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":653.54,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":640.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":627.92,"methodology":"fee schedule"}]}]},{"description":"Twin zygosity, genomic targeted sequence analysis of cromosome 2, using circulating cell-free fetal DNA in maternal blood ","code_information":[{"code":"0060U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":743.87,"maximum":2171.07,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":797.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":751.46,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":774.23,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2171.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2171.07,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2083.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":759.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":743.87,"methodology":"fee schedule"}]}]},{"description":"Upper extremity addition, spring assisted rotational wrist unit with latch release ","code_information":[{"code":"L6623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":736.83,"maximum":789.46,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":751.87,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":751.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":751.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":751.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":751.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":751.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":751.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":751.87,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":751.87,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":789.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":751.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":744.35,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":766.91,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":751.87,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":751.87,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":751.87,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":751.87,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":751.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":736.83,"methodology":"fee schedule"}]}]},{"description":"Virtual reality cognitive behavioral therapy device (cbt), including pre-programmed therapy software ","code_information":[{"code":"E1905","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":633.12,"maximum":678.34,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":646.04,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":646.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":646.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":646.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":646.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":646.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":646.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":646.04,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":646.04,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":678.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":646.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":639.58,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":658.96,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":646.04,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":646.04,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":646.04,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":646.04,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":646.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":633.12,"methodology":"fee schedule"}]}]},{"description":"Wrist hand finger orthosis, dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated ","code_information":[{"code":"L3901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2172.35,"maximum":2327.51,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2216.68,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2216.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2216.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2216.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2216.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2216.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2216.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2216.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2216.68,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2327.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2216.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2194.51,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2261.01,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2216.68,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2216.68,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2216.68,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2216.68,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2216.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2172.35,"methodology":"fee schedule"}]}]},{"description":"HTT (huntingtin) (eg, Huntington disease) gene analysis; characterization of alleles (eg, expanded size) ","code_information":[{"code":"81274","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":250.80,"maximum":288.57,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":288.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":272.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":280.33,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":261.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":261.36,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":250.80,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":274.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":269.33,"methodology":"fee schedule"}]}]},{"description":"Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single-step method (eg, reagent strip); ","code_information":[{"code":"86318","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.10,"maximum":18.99,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":18.99,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":17.91,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":18.45,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":17.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":18.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":17.73,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay ºEIA», enzyme-linked immunosorbent assay ºELISA», fluorescence immunoassay ºFIA», immunochemiluminometric assay ºIMC ","code_information":[{"code":"87451","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.30,"maximum":33.66,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":11.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":10.40,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":10.72,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":32.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":10.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10.30,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Borrelia miyamotoi, amplified probe technique ","code_information":[{"code":"87478","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34.39,"maximum":36.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":34.39,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification, includes reverse transcription when performed ","code_information":[{"code":"87536","type":"CPT"},{"code":"903177","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":83.40,"maximum":99.99,"gross_charge":823.28,"discounted_cash":823.28,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":89.36,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":84.25,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":86.80,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":95.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":85.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":83.40,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus) ","code_information":[{"code":"87631","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":116.85,"maximum":149.76,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":149.76,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":141.20,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":145.48,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":121.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":121.77,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":116.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":142.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":139.78,"methodology":"fee schedule"}]}]},{"description":"Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) ","code_information":[{"code":"A4222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":45.46,"maximum":48.71,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":48.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":45.93,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":47.32,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":46.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":45.46,"methodology":"fee schedule"}]}]},{"description":"KIT (v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, gastrointestinal stromal tumor ºGIST», acute myeloid leukemia, melanoma), gene analysis, targeted sequence analysis (eg, exons ","code_information":[{"code":"81272","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":322.92,"maximum":745.47,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":345.99,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":326.21,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":336.10,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":745.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":745.47,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":715.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":329.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":322.92,"methodology":"fee schedule"}]}]},{"description":"Leukocyte phagocytosis ","code_information":[{"code":"86344","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.18,"maximum":60.39,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":10.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":10.29,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":10.60,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":60.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":60.39,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":57.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":10.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10.18,"methodology":"fee schedule"}]}]},{"description":"Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lat ","code_information":[{"code":"L0638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1537.53,"maximum":1647.36,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1568.91,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1568.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1568.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1568.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1568.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1568.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1568.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1568.91,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1568.91,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1647.36,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1568.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1553.22,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1600.29,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1568.91,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1568.91,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1568.91,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1568.91,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1568.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1537.53,"methodology":"fee schedule"}]}]},{"description":"Microphone for use with cochlear implant device, replacement ","code_information":[{"code":"L8616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":122.91,"maximum":131.69,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":125.42,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":125.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":125.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":125.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":125.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":125.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":125.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":125.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":125.42,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":131.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":125.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":124.17,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":127.93,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":125.42,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":125.42,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":125.42,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":125.42,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":125.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":122.91,"methodology":"fee schedule"}]}]},{"description":"Narrowing device, wheelchair ","code_information":[{"code":"E0969","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":194.36,"maximum":208.25,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":208.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":196.35,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":202.30,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":198.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":194.36,"methodology":"fee schedule"}]}]},{"description":"Normal, low and high calibrator solution / chips ","code_information":[{"code":"A4256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3.31,"maximum":3.55,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3.35,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3.45,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3.31,"methodology":"fee schedule"}]}]},{"description":"Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by DAPI stain and morphology, predictive algorithm reported as a drug response score; first single drug or drug combinatio ","code_information":[{"code":"81535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":567.87,"maximum":11080.08,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":579.46,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":579.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":579.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":579.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":579.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":579.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":579.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":579.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":579.46,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":608.43,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":579.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":573.67,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":591.05,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":579.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":11080.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":11080.08,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":579.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10632.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":579.46,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":579.46,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":579.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":567.87,"methodology":"fee schedule"}]}]},{"description":"Oncology (thyroid), DNA and mRNA, next generation sequencing analysis of 112 genes, fine needle aspirate or formalin-fixed paraffin-embedded (FFPE) tissue, algorithmic prediction of cancer recurrence, ","code_information":[{"code":"0287U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3528.00,"maximum":3780.00,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3780.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3564.00,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3672.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3528.00,"methodology":"fee schedule"}]}]},{"description":"Osmolality; blood ","code_information":[{"code":"83930","type":"CPT"},{"code":"902575","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":6.48,"maximum":78.21,"gross_charge":241.62,"discounted_cash":241.62,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":6.94,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":6.54,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":6.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":78.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":78.21,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":75.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":6.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":6.48,"methodology":"fee schedule"}]}]},{"description":"Ostomy pouch, urinary, for use on faceplate, plastic, each ","code_information":[{"code":"A4381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6.18,"maximum":6.63,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":6.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":6.25,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":6.44,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":6.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":6.18,"methodology":"fee schedule"}]}]},{"description":"Pacemaker monitor, self-contained, (checks battery depletion, includes audible and visible check systems) ","code_information":[{"code":"E0610","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":318.04,"maximum":340.76,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":324.53,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":324.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":324.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":324.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":324.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":324.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":324.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":324.53,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":324.53,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":340.76,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":324.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":321.28,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":331.02,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":324.53,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":324.53,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":324.53,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":324.53,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":324.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":318.04,"methodology":"fee schedule"}]}]},{"description":"Pelvic belt/harness/boot ","code_information":[{"code":"E0944","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":61.34,"maximum":65.72,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":65.72,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":61.96,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":63.84,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":62.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":61.34,"methodology":"fee schedule"}]}]},{"description":"Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware ","code_information":[{"code":"E2620","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":439.68,"maximum":471.08,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":448.65,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":448.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":448.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":448.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":448.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":448.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":448.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":448.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":448.65,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":471.08,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":448.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":444.16,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":457.62,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":448.65,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":448.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":448.65,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":448.65,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":448.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":439.68,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair component, drive wheel motor, replacement only ","code_information":[{"code":"E2368","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":44.86,"maximum":48.07,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":48.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":45.32,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":46.70,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":45.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":44.86,"methodology":"fee schedule"}]}]},{"description":"Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, thermoplastic or equal, direct formed ","code_information":[{"code":"L5570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2952.01,"maximum":3162.86,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3162.86,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2982.13,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3072.49,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3012.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2952.01,"methodology":"fee schedule"}]}]},{"description":"Prosthetic sock, multiple ply, below knee, each ","code_information":[{"code":"L8420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22.33,"maximum":23.93,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":23.93,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22.56,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":23.25,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22.33,"methodology":"fee schedule"}]}]},{"description":"Red cell antigen (H blood group) genotyping (FUT2), gene analysis, FUT2 (fycosyltransferase 2) exon 2 ","code_information":[{"code":"0186U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":181.50,"maximum":529.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":194.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":183.35,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":529.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":529.65,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":508.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":181.50,"methodology":"fee schedule"}]}]},{"description":"Replacement battery for external infusion pump owned by patient, lithium, 4.5 volt, each ","code_information":[{"code":"K0605","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":18.94,"maximum":20.30,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":20.30,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":19.14,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":19.72,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":19.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18.94,"methodology":"fee schedule"}]}]},{"description":"Semen analysis; presence and/or motility of sperm including Huhner test (post coital) ","code_information":[{"code":"89300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9.64,"maximum":1125.63,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":10.04,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1125.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1125.63,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1080.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":9.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9.64,"methodology":"fee schedule"}]}]},{"description":"Skin barrier; solid, 8 x 8 or equivalent, each ","code_information":[{"code":"A5122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":17.17,"maximum":18.40,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":17.34,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":17.87,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":17.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":17.17,"methodology":"fee schedule"}]}]},{"description":"Special wheelchair seat depth and/or width, by construction ","code_information":[{"code":"E1298","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":481.52,"maximum":515.92,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":491.35,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":491.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":491.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":491.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":491.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":491.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":491.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":491.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":491.35,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":515.92,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":491.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":486.44,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":501.18,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":491.35,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":491.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":491.35,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":491.35,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":491.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":481.52,"methodology":"fee schedule"}]}]},{"description":"Spherocylinder, trifocal, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens ","code_information":[{"code":"V2313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":114.95,"maximum":123.17,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":117.30,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":117.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":117.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":117.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":117.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":117.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":117.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":117.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":117.30,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":123.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":117.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":116.13,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":119.65,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":117.30,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":117.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":117.30,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":117.30,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":117.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":114.95,"methodology":"fee schedule"}]}]},{"description":"TBP (TATA box binding protein) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles ","code_information":[{"code":"81344","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134.26,"maximum":596.97,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":135.63,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":596.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":596.97,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":572.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":134.26,"methodology":"fee schedule"}]}]},{"description":"Tissue culture for neoplastic disorders; solid tumor ","code_information":[{"code":"88239","type":"CPT"},{"code":"919193","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":144.57,"maximum":332.64,"gross_charge":813.49,"discounted_cash":813.49,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":154.90,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":146.04,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":150.47,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":332.64,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":319.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":147.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":144.57,"methodology":"fee schedule"}]}]},{"description":"Toxin or antitoxin assay, tissue culture (eg, Clostridium difficile toxin) ","code_information":[{"code":"87230","type":"CPT"},{"code":"947236","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":16.15,"maximum":20.73,"gross_charge":271.18,"discounted_cash":271.18,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":20.73,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":19.54,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":20.13,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19.35,"methodology":"fee schedule"}]}]},{"description":"Triiodothyronine T3; total (TT-3) ","code_information":[{"code":"84480","type":"CPT"},{"code":"902523","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":13.90,"maximum":14.89,"gross_charge":7.50,"discounted_cash":7.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":14.89,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14.04,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":14.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":13.90,"methodology":"fee schedule"}]}]},{"description":"Upper extremity addition, standard control cable, extra ","code_information":[{"code":"L6655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":86.29,"maximum":92.45,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":92.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":87.17,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":89.81,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":88.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":86.29,"methodology":"fee schedule"}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC ","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC ","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"MACRO EXAM ARTHROPOD ","code_information":[{"code":"87168","type":"CPT"},{"code":"947221","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":205.80,"discounted_cash":205.80,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":110.93,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":90.96,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":76.15,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":139.94,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":76.15,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":123.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":98.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":65.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":68.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":58.04,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":117.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":185.22,"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":174.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":144.06,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":82.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":185.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":92.61,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":44.66,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":37.04,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":133.77,"methodology":"percent of total billed charges"}]}]},{"description":"MAG AB CONF WB-BD ","code_information":[{"code":"84182","type":"CPT"},{"code":"936088","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":820.28,"discounted_cash":820.28,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":442.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":362.56,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":303.50,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":557.79,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":303.50,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":492.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":391.27,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":260.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":273.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":231.32,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":469.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":738.25,"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":697.24,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":574.20,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":328.11,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":738.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":369.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":178.00,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":147.65,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":533.18,"methodology":"percent of total billed charges"}]}]},{"description":"MAG SULFATE 50% 10ML ","code_information":[{"code":"908720","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":58.59,"discounted_cash":58.59,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":31.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":17.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":25.90,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":39.84,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":35.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":27.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":18.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":19.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":16.52,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":33.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":52.73,"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":49.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":41.01,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":23.44,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":43.94,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":52.73,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":46.87,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":26.37,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":12.71,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":10.55,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":38.08,"methodology":"percent of total billed charges"}]}]},{"description":"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND CO ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT ","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":29790.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":29790.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":24933.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 4. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC ","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC ","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"MALIGNANT BREAST DISORDERS WITH MCC ","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"MANNITOL 20% 500ML INJ ","code_information":[{"code":"907072","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":227.39,"discounted_cash":227.39,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":122.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":68.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":100.51,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":154.63,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":136.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":108.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":72.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":75.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":64.12,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":130.07,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":204.65,"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":193.28,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":159.17,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":90.96,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":170.54,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":204.65,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":181.91,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":102.33,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":49.34,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":40.93,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":147.80,"methodology":"percent of total billed charges"}]}]},{"description":"MANUAL THER TECH 15M OT ","code_information":[{"code":"903968","type":"CDM"},{"code":"97140","type":"CPT"}],"standard_charges":[{"modifiers":"GO","modifiers_description":"Services delivered under an outpatient occupational therapy plan of care","setting":"outpatient","gross_charge":385.56,"discounted_cash":385.56,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":207.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":115.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":170.42,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":142.66,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":262.18,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":142.66,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":231.34,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":183.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":122.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":128.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":108.73,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":220.54,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":347.00,"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":327.73,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":269.89,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":154.22,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":347.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":308.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":173.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":83.67,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":69.40,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":250.61,"methodology":"percent of total billed charges"}]}]},{"description":"MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC ","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC ","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"MENTH/CAMPH/ALUM OINT ","code_information":[{"code":"909636","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":122.57,"discounted_cash":122.57,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":66.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":36.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":54.18,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":83.35,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":73.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":58.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":38.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":40.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":34.56,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":70.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":110.31,"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":104.18,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":85.80,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":49.03,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":91.93,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":110.31,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":98.06,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":55.16,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":26.60,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":22.06,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":79.67,"methodology":"percent of total billed charges"}]}]},{"description":"MENTHOL/CAMPH/EUCA OIL ","code_information":[{"code":"909571","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":155.23,"discounted_cash":155.23,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":83.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":46.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":68.61,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":105.56,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":93.14,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":74.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":49.21,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":51.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":43.77,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":88.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":139.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":131.95,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":108.66,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":62.09,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":116.42,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":139.71,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":124.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":69.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":33.68,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":27.94,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":100.90,"methodology":"percent of total billed charges"}]}]},{"description":"MEPERIDINE 50 MG INJ ","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"908031","type":"CDM"},{"code":"J2175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":106.81,"discounted_cash":106.81,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":57.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":32.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":47.21,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":39.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":72.63,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":39.52,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":64.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":50.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":33.86,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":35.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":30.12,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":61.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":96.13,"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":90.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":74.77,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":42.72,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":80.11,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":96.13,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":85.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":48.06,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":23.18,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":19.23,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":69.43,"methodology":"percent of total billed charges"}]}]},{"description":"MEPERIDINE 75MG INJ ","code_information":[{"code":"908018","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":158.47,"discounted_cash":158.47,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":85.42,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":47.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":70.04,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":107.76,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":95.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":75.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":50.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":52.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":44.69,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":90.64,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":142.62,"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":134.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":110.93,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":63.39,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":118.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":142.62,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":126.78,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":71.31,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":34.39,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":28.52,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":103.01,"methodology":"percent of total billed charges"}]}]},{"description":"BURNS; M=12-45 ","code_information":[{"code":"D2102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":33674.35,"maximum":35409.41,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":35409.41,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":35409.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":35409.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":35409.41,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":35409.41,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":35409.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":33674.35,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M > 31.15 & M < 38.55 ","code_information":[{"code":"D1403","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24526.77,"maximum":25790.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":24526.77,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M > 48.85 ","code_information":[{"code":"D1401","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15805.59,"maximum":16619.97,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16619.97,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16619.97,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16619.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16619.97,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16619.97,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16619.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15805.59,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M < 28.15 ","code_information":[{"code":"C0704","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":34423.90,"maximum":36197.59,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":36197.59,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":36197.59,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":36197.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":36197.59,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":36197.59,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":36197.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":34423.90,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 34.15 & M < 42.15 ","code_information":[{"code":"C0702","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22914.85,"maximum":24095.53,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":24095.53,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":24095.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":24095.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":24095.53,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":24095.53,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":24095.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22914.85,"methodology":"fee schedule"}]}]},{"description":"GUILLIAN BARRE; M < 18.05 ","code_information":[{"code":"C1903","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":36917.31,"maximum":38819.46,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":38819.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":38819.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":38819.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":38819.46,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":38819.46,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":38819.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":36917.31,"methodology":"fee schedule"}]}]},{"description":"GUILLIAN BARRE; M > 35.95 ","code_information":[{"code":"C1901","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15291.23,"maximum":16079.10,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16079.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16079.10,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16079.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16079.10,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16079.10,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16079.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15291.23,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA NO BRAIN OR SPINAL CORD INJURY; M ","code_information":[{"code":"D1702","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22867.05,"maximum":24045.27,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":24045.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":24045.27,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":24045.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":24045.27,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":24045.27,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":24045.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22867.05,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA NO BRAIN OR SPINAL CORD INJU ","code_information":[{"code":"C1701","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19872.67,"maximum":20896.60,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":20896.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":20896.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":20896.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":20896.60,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":20896.60,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":20896.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19872.67,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CORD IN ","code_information":[{"code":"B1801","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20274.21,"maximum":21318.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":21318.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":21318.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":21318.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":21318.84,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":21318.84,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":21318.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":20274.21,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA,NO BRAIN OR SPINAL CORD INJU ","code_information":[{"code":"C1704","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":33207.80,"maximum":34918.82,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":34918.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":34918.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":34918.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34918.82,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":34918.82,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":34918.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":33207.80,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 27.85 & M < 38.75 ","code_information":[{"code":"C2003","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26918.83,"maximum":28305.82,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":28305.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":28305.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":28305.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":28305.82,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":28305.82,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":28305.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":26918.83,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 49.15 ","code_information":[{"code":"C2001","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18029.38,"maximum":18958.34,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":18958.34,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":18958.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":18958.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":18958.34,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":18958.34,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":18958.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18029.38,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M < 25.85 ","code_information":[{"code":"C0604","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":35651.49,"maximum":37488.42,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":37488.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":37488.42,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":37488.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":37488.42,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":37488.42,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":37488.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":35651.49,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 37.35 & M < 47.75 ","code_information":[{"code":"C0602","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24127.14,"maximum":25370.28,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":25370.28,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":25370.28,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":25370.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":25370.28,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":25370.28,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":25370.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":24127.14,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M < 26.15 ","code_information":[{"code":"C0304","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":33075.86,"maximum":34780.08,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":34780.08,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":34780.08,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":34780.08,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34780.08,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":34780.08,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":34780.08,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":33075.86,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 35.05 & M < 41.05 ","code_information":[{"code":"C0302","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23710.29,"maximum":24931.96,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":24931.96,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":24931.96,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":24931.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":24931.96,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":24931.96,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":24931.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":23710.29,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 23.75 & M < 2 ","code_information":[{"code":"C0505","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":44869.82,"maximum":47181.72,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":47181.72,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":47181.72,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":47181.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":47181.72,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":47181.72,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":47181.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":44869.82,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 31.25 & M < 4 ","code_information":[{"code":"C0503","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27163.58,"maximum":28563.18,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":28563.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":28563.18,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":28563.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":28563.18,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":28563.18,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":28563.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":27163.58,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 51.35 ","code_information":[{"code":"C0501","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18889.84,"maximum":19863.13,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":19863.13,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":19863.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":19863.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":19863.13,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":19863.13,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":19863.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18889.84,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M > 30.75 & M < 37.65 ","code_information":[{"code":"C1202","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23366.11,"maximum":24570.04,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":24570.04,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":24570.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":24570.04,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":24570.04,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":24570.04,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":24570.04,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":23366.11,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M=39-47 ","code_information":[{"code":"C1204","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31745.02,"maximum":33380.68,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":33380.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":33380.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":33380.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":33380.68,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":33380.68,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":33380.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":31745.02,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M > 24.15 & M < 34.35 ","code_information":[{"code":"C0903","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27372.00,"maximum":28782.34,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":28782.34,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":28782.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":28782.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":28782.34,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":28782.34,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":28782.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":27372.00,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M > 44.75 ","code_information":[{"code":"C0901","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18404.16,"maximum":19352.43,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":19352.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":19352.43,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":19352.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":19352.43,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":19352.43,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":19352.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18404.16,"methodology":"fee schedule"}]}]},{"description":"PAIN SYNDROME; M > 26.75 & M < 37.15 ","code_information":[{"code":"C1602","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21308.67,"maximum":22406.59,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22406.59,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22406.59,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22406.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22406.59,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22406.59,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22406.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":21308.67,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M < 29.15 ","code_information":[{"code":"C1504","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":35297.74,"maximum":37116.45,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":37116.45,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":37116.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":37116.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":37116.45,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":37116.45,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":37116.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":35297.74,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 39.05 & M < 49.25 ","code_information":[{"code":"C1502","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25079.37,"maximum":26371.58,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":26371.58,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":26371.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":26371.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":26371.58,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":26371.58,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":26371.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":25079.37,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXT JOINT; M > 28.65 & M < 37 ","code_information":[{"code":"B0803","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":29333.84,"maximum":30845.26,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":30845.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":30845.26,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":30845.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":30845.26,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":30845.26,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":30845.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":29333.84,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 22.05 & ","code_information":[{"code":"C0805","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31626.47,"maximum":33256.02,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":33256.02,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":33256.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":33256.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":33256.02,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":33256.02,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":33256.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":31626.47,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 49.55 ","code_information":[{"code":"C0801","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18652.74,"maximum":19613.81,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":19613.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":19613.81,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":19613.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":19613.81,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":19613.81,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":19613.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18652.74,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M < 26.15 ","code_information":[{"code":"A1303","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23807.81,"maximum":25034.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":25034.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":25034.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":25034.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":25034.50,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":25034.50,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":25034.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":23807.81,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M > 36.35 ","code_information":[{"code":"A1301","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15308.44,"maximum":16097.20,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16097.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16097.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16097.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16097.20,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16097.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16097.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15308.44,"methodology":"fee schedule"}]}]},{"description":"SHORT STAY CASES, LENGTH OF STAY IS 3 DAYS OR FEWE ","code_information":[{"code":"A5001","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":3269.73,"maximum":3438.20,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3438.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3438.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3438.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3438.20,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3438.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3438.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3269.73,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 34.25 & M < 38.85 ","code_information":[{"code":"D0105","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":38722.35,"maximum":40717.51,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":40717.51,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":40717.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":40717.51,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":40717.51,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":40717.51,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":40717.51,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":38722.35,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 44.45 & M < 51.05 & C < 18.5 ","code_information":[{"code":"D0103","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24264.81,"maximum":25515.05,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":25515.05,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":25515.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":25515.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":25515.05,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":25515.05,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":25515.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":24264.81,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 51.05 ","code_information":[{"code":"D0101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14836.14,"maximum":15600.57,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":15600.57,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":15600.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":15600.57,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":15600.57,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":15600.57,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":15600.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14836.14,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 40.65 & M < 44.25 ","code_information":[{"code":"D0204","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":29463.86,"maximum":30981.98,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":30981.98,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":30981.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":30981.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":30981.98,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":30981.98,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":30981.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":29463.86,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 44.25 & M < 53.35 & C ","code_information":[{"code":"D0202","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19075.31,"maximum":20058.16,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":20058.16,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":20058.16,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":20058.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":20058.16,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":20058.16,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":20058.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19075.31,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M < 16.05 & A < 63.5 ","code_information":[{"code":"D0405","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":40005.38,"maximum":42066.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":42066.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":42066.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":42066.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":42066.65,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":42066.65,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":42066.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":40005.38,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M > 16.05 & M < 30.3 ","code_information":[{"code":"D0403","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32219.23,"maximum":33879.32,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":33879.32,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":33879.32,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":33879.32,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":33879.32,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":33879.32,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":33879.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":32219.23,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M > 48.45 ","code_information":[{"code":"D0401","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19907.09,"maximum":20932.79,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":20932.79,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":20932.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":20932.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":20932.79,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":20932.79,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":20932.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19907.09,"methodology":"fee schedule"}]}]},{"description":" Coronary Care Unit Other Coronary CCU  ","code_information":[{"code":"219","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":1700.00,"maximum":1700.00,"payers_information":[{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1700.00,"methodology":"per diem"}]}]},{"description":" Cardiology General Classification  ","code_information":[{"code":"480","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1043.00,"maximum":1353.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1353.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1043.00,"methodology":"case rate"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":" Ambulatory Surgical Care General Classification  ","code_information":[{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":" Operating Room Services General Classification  ","code_information":[{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":"Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without transplantation of prepuce and/or skin flaps ","code_information":[{"code":"54304","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy (specify number of doses); 5 single stinging insect venoms ","code_information":[{"code":"95149","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":65.55,"maximum":68.31,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":68.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":68.31,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":65.55,"methodology":"fee schedule"}]}]},{"description":"Pulmonary perfusion imaging (eg, particulate) ","code_information":[{"code":"78580","type":"CPT"},{"code":"903686","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":2440.55,"maximum":2543.31,"gross_charge":2289.56,"discounted_cash":2289.56,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2543.31,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2543.31,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2440.55,"methodology":"fee schedule"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of upper arm or elbow area; 5 cm or greater ","code_information":[{"code":"24079","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination, radiostereometric analysis (RSA); upper extremity(ies), (includes shoulder, elbow, and wrist, when performed) ","code_information":[{"code":"0349T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179.55,"maximum":187.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination; tibia and fibula, 2 views ","code_information":[{"code":"73590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133.00,"maximum":138.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":133.00,"methodology":"fee schedule"}]}]},{"description":"Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); with LeFort I ","code_information":[{"code":"21155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 2-12 channels ","code_information":[{"code":"77771","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1169.45,"maximum":1218.69,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1218.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1218.69,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1169.45,"methodology":"fee schedule"}]}]},{"description":"Removal of foreign body, intraocular; from anterior chamber of eye or lens ","code_information":[{"code":"65235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3424.75,"maximum":3568.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3424.75,"methodology":"fee schedule"}]}]},{"description":"Removal of lens material; aspiration technique, 1 or more stages ","code_information":[{"code":"66840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3424.75,"maximum":3568.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3424.75,"methodology":"fee schedule"}]}]},{"description":"Repair blood vessel with graft other than vein; lower extremity ","code_information":[{"code":"35286","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7865.05,"maximum":8196.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7865.05,"methodology":"fee schedule"}]}]},{"description":"Repair of enterocele, vaginal approach (separate procedure) ","code_information":[{"code":"57268","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7272.25,"maximum":7578.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7578.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7578.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7272.25,"methodology":"fee schedule"}]}]},{"description":"Repair of scleral staphyloma with graft ","code_information":[{"code":"66225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6459.05,"maximum":6731.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":6731.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":6731.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":6459.05,"methodology":"fee schedule"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm ","code_information":[{"code":"12052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":570.00,"maximum":594.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":570.00,"methodology":"fee schedule"}]}]},{"description":"Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous pump, through same venous access ","code_information":[{"code":"36583","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7865.05,"maximum":8196.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7865.05,"methodology":"fee schedule"}]}]},{"description":"Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed ","code_information":[{"code":"63663","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10166.90,"maximum":10594.98,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10594.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10594.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10166.90,"methodology":"fee schedule"}]}]},{"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":"49185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1026.00,"maximum":1069.20,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1026.00,"methodology":"fee schedule"}]}]},{"description":"Sigmoidoscopy, flexible; with endoscopic mucosal resection ","code_information":[{"code":"45349","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4028.95,"maximum":4198.59,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4028.95,"methodology":"fee schedule"}]}]},{"description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with biopsy, single or multiple ","code_information":[{"code":"44361","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2678.05,"maximum":2790.81,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2790.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2790.81,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2678.05,"methodology":"fee schedule"}]}]},{"description":"Splitting of blood or blood products, each unit ","code_information":[{"code":"86985","type":"CPT"},{"code":"902411","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":447.45,"maximum":466.29,"gross_charge":173.00,"discounted_cash":173.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":466.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":466.29,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":447.45,"methodology":"fee schedule"}]}]},{"description":"Tenodesis of long tendon of biceps ","code_information":[{"code":"23430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Thawing of cryopreserved; reproductive tissue, testicular/ovarian ","code_information":[{"code":"89354","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":245.10,"maximum":255.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":245.10,"methodology":"fee schedule"}]}]},{"description":"Tonsillectomy, primary or secondary; younger than age 12 ","code_information":[{"code":"42825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Transcatheter placement of an intravascular stent(s), open or percutaneous, including radiological supervision and interpretation and including angioplasty within the same vessel, when performed; init ","code_information":[{"code":"37238","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16567.05,"maximum":17264.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":17264.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":17264.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":16567.05,"methodology":"fee schedule"}]}]},{"description":"Transfer external oblique muscle to greater trochanter including fascial or tendon extension (graft) ","code_information":[{"code":"27100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; thoracic ","code_information":[{"code":"63055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, with ossicular chain reconstruction ","code_information":[{"code":"69646","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Unlisted cardiovascular service or procedure ","code_information":[{"code":"93799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Unlisted maxillofacial prosthetic procedure ","code_information":[{"code":"21089","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":348.65,"maximum":363.33,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":363.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":363.33,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":348.65,"methodology":"fee schedule"}]}]},{"description":"Unlisted procedure, clinical brachytherapy ","code_information":[{"code":"77799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1169.45,"maximum":1218.69,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1218.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1218.69,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1169.45,"methodology":"fee schedule"}]}]},{"description":"Unlisted transfusion medicine procedure ","code_information":[{"code":"86999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39.90,"maximum":41.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":39.90,"methodology":"fee schedule"}]}]},{"description":"VAGUS NERVE BLOCKING THERAPY (MORBID OBESITY); NEUROSTIMULATOR PULSE GENERATOR ELECTRONIC ANALYSIS, INCLUDES REPROGRAMMING WHEN PERFORMED ","code_information":[{"code":"0317T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60.80,"maximum":63.36,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":60.80,"methodology":"fee schedule"}]}]},{"description":"Venography, orbital, radiological supervision and interpretation ","code_information":[{"code":"75880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7865.05,"maximum":8196.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7865.05,"methodology":"fee schedule"}]}]},{"description":"Vulvectomy simple; partial ","code_information":[{"code":"56620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4327.25,"maximum":4509.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4327.25,"methodology":"fee schedule"}]}]},{"description":"Adenoidectomy, secondary; age 12 or over ","code_information":[{"code":"42836","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"Amputation, thigh, through femur, any level; re-amputation ","code_information":[{"code":"27596","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Aortography, thoracic, by serialography, radiological supervision and interpretation ","code_information":[{"code":"75605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":294.50,"maximum":306.90,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":306.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":306.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":294.50,"methodology":"fee schedule"}]}]},{"description":"Application of short arm splint (forearm to hand); dynamic ","code_information":[{"code":"29126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, carpometacarpal joint, digit, other than thumb, each; with autograft (includes obtaining graft) ","code_information":[{"code":"26844","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, hip, surgical; with removal of loose body or foreign body ","code_information":[{"code":"29861","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, wrist, surgical; synovectomy, complete ","code_information":[{"code":"29845","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact, with wr ","code_information":[{"code":"97755","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":50.35,"maximum":52.47,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":50.35,"methodology":"fee schedule"}]}]},{"description":"Biopsy of tongue; anterior two-thirds ","code_information":[{"code":"41100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":745.75,"maximum":777.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":777.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":777.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":745.75,"methodology":"fee schedule"}]}]},{"description":"Blood-derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologous ","code_information":[{"code":"38206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2249.60,"maximum":2344.32,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2344.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2344.32,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2249.60,"methodology":"fee schedule"}]}]},{"description":"Brachytherapy source, non-stranded, gold-198, per source ","code_information":[{"code":"C1716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":900.60,"maximum":938.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":938.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":938.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":900.60,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspirationºs»/biopsyºies ","code_information":[{"code":"31653","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5109.10,"maximum":5324.22,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5324.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5324.22,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5109.10,"methodology":"fee schedule"}]}]},{"description":"Capsulotomy, posterior capsular release, knee ","code_information":[{"code":"27435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Cautery of cervix; electro or thermal ","code_information":[{"code":"57510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4327.25,"maximum":4509.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4327.25,"methodology":"fee schedule"}]}]},{"description":"Ciliary body destruction; cyclodialysis ","code_information":[{"code":"66740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation ","code_information":[{"code":"25600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of metatarsophalangeal joint dislocation; without anesthesia ","code_information":[{"code":"28630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Cochlear device implantation, with or without mastoidectomy ","code_information":[{"code":"69930","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen; without contrast material ","code_information":[{"code":"74150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133.00,"maximum":138.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":133.00,"methodology":"fee schedule"}]}]},{"description":"Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial ","code_information":[{"code":"30905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy with incision, fulguration, or resection of congenital posterior urethral valves, or congenital obstructive hypertrophic mucosal folds ","code_information":[{"code":"52400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy; with resection or fulguration of orthotopic ureterocele(s), unilateral or bilateral ","code_information":[{"code":"52300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output ","code_information":[{"code":"99465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195.70,"maximum":203.94,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":203.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":203.94,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":195.70,"methodology":"fee schedule"}]}]},{"description":"Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; electrodesiccation ","code_information":[{"code":"46910","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2824.35,"maximum":2943.27,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2824.35,"methodology":"fee schedule"}]}]},{"description":"Dilation and curettage of cervical stump ","code_information":[{"code":"57558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4327.25,"maximum":4509.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4327.25,"methodology":"fee schedule"}]}]},{"description":"Drainage of palmar bursa; single, bursa ","code_information":[{"code":"26025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode recording; follow-up or repeat study ","code_information":[{"code":"76826","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179.55,"maximum":187.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); without reprogramming o ","code_information":[{"code":"62367","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450.30,"maximum":469.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":469.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":469.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":450.30,"methodology":"fee schedule"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); with sphincterotomy/papillotomy ","code_information":[{"code":"43262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5064.45,"maximum":5277.69,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5064.45,"methodology":"fee schedule"}]}]},{"description":"Esophageal mucosal integrity testing by electrical impedance, transoral, includes esophagoscopy or esophagogastroduodenoscopy ","code_information":[{"code":"C9777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16567.05,"maximum":17264.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":17264.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":17264.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":16567.05,"methodology":"fee schedule"}]}]},{"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":"67961","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Excision of mucosa of vestibule of mouth as donor graft ","code_information":[{"code":"40818","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":745.75,"maximum":777.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":777.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":777.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":745.75,"methodology":"fee schedule"}]}]},{"description":"Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with complex repair ","code_information":[{"code":"11463","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor, tibia or fibula; with autograft (includes obtaining graft) ","code_information":[{"code":"27637","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Excision, interdigital (Morton) neuroma, single, each ","code_information":[{"code":"28080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Excision, tumor, soft tissue of foot or toe, subcutaneous; 1.5 cm or greater ","code_information":[{"code":"28039","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with ","code_information":[{"code":"93229","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91.20,"maximum":95.04,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":91.20,"methodology":"fee schedule"}]}]},{"description":"Fine needle aspiration biopsy, including ultrasound guidance; first lesion ","code_information":[{"code":"10005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1026.00,"maximum":1069.20,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1026.00,"methodology":"fee schedule"}]}]},{"description":"Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral ","code_information":[{"code":"92235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55.10,"maximum":57.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":55.10,"methodology":"fee schedule"}]}]},{"description":"Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia) ","code_information":[{"code":"15769","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5807.35,"maximum":6051.87,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":6051.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":6051.87,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5807.35,"methodology":"fee schedule"}]}]},{"description":"Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation ","code_information":[{"code":"G0399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":525.35,"maximum":547.47,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":547.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":547.47,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":525.35,"methodology":"fee schedule"}]}]},{"description":"Impression and custom preparation; auricular prosthesis ","code_information":[{"code":"21086","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"Incision, bone cortex (eg, osteomyelitis or bone abscess), shoulder area ","code_information":[{"code":"23035","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed b ","code_information":[{"code":"G2214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":220.40,"maximum":229.68,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":229.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":229.68,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":220.40,"methodology":"fee schedule"}]}]},{"description":"Injection, asparaginase, recombinant, (rylaze), 0.1 mg ","code_information":[{"code":"J9021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1.90,"maximum":1.98,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1.90,"methodology":"fee schedule"}]}]},{"description":"Injection, crizanlizumab-tmca, 5 mg ","code_information":[{"code":"J0791","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":32.30,"maximum":33.66,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":32.30,"methodology":"fee schedule"}]}]},{"description":"Injection, factor viii fc fusion protein (recombinant), per iu ","code_information":[{"code":"J7205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4.75,"maximum":4.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4.75,"methodology":"fee schedule"}]}]},{"description":"Injection, infliximab-axxq, biosimilar, (avsola), 10 mg ","code_information":[{"code":"Q5121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":68.40,"maximum":71.28,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":68.40,"methodology":"fee schedule"}]}]},{"description":"Injection, pegloticase, 1 mg ","code_information":[{"code":"J2507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":38.00,"maximum":39.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":39.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":39.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":38.00,"methodology":"fee schedule"}]}]},{"description":"Injection, verteporfin, 0.1 mg ","code_information":[{"code":"J3396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":267.90,"maximum":279.18,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":279.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":279.18,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":267.90,"methodology":"fee schedule"}]}]},{"description":"INSERTION OR REPLACEMENT OF NEUROSTIMULATOR SYSTEM FOR TREATMENT OF CENTRAL SLEEP APNEA; STIMULATION LEAD ONLY ","code_information":[{"code":"0426T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18544.95,"maximum":19325.79,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":19325.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":19325.79,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":18544.95,"methodology":"fee schedule"}]}]},{"description":"Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; complete procedure excluding bone mar ","code_information":[{"code":"0264T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6669.95,"maximum":6950.79,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":6950.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":6950.79,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":6669.95,"methodology":"fee schedule"}]}]},{"description":"Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic) ","code_information":[{"code":"78709","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":621.30,"maximum":647.46,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":621.30,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) ","code_information":[{"code":"58571","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14689.85,"maximum":15308.37,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":14689.85,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn ","code_information":[{"code":"31525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2467.15,"maximum":2571.03,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2571.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2571.03,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2467.15,"methodology":"fee schedule"}]}]},{"description":"Ligamentous reconstruction (augmentation), knee; intra-articular (open) ","code_information":[{"code":"27428","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20337.60,"maximum":21193.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s) ","code_information":[{"code":"73722","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Meatotomy, cutting of meatus (separate procedure); infant ","code_information":[{"code":"53025","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2952.60,"maximum":3076.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3076.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3076.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2952.60,"methodology":"fee schedule"}]}]},{"description":"Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation ","code_information":[{"code":"72270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133.00,"maximum":138.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":133.00,"methodology":"fee schedule"}]}]},{"description":"Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical app ","code_information":[{"code":"97608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":295.45,"maximum":307.89,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":295.45,"methodology":"fee schedule"}]}]},{"description":"Oncology (prostate cancer), FISH analysis of 4 genes, needle biopsy specimen, algorithm reported as probability of higher tumor grade ","code_information":[{"code":"0053U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5572.70,"maximum":5807.34,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5807.34,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5807.34,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5572.70,"methodology":"fee schedule"}]}]},{"description":"Open treatment of metatarsal fracture, includes internal fixation, when performed, each ","code_information":[{"code":"28485","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Opponensplasty; superficialis tendon transfer type, each tendon ","code_information":[{"code":"26490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Osteoplasty, humerus (eg, shortening or lengthening) (excluding 64876) ","code_information":[{"code":"24420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Paracentesis of anterior chamber of eye (separate procedure); with removal of vitreous and/or discission of anterior hyaloid membrane, with or without air injection ","code_information":[{"code":"65810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3424.75,"maximum":3568.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3424.75,"methodology":"fee schedule"}]}]},{"description":"Pedicle soft tissue graft pr ","code_information":[{"code":"D4270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2287.60,"maximum":2383.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2287.60,"methodology":"fee schedule"}]}]},{"description":"Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance ","code_information":[{"code":"37187","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16567.05,"maximum":17264.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":17264.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":17264.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":16567.05,"methodology":"fee schedule"}]}]},{"description":"Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance ","code_information":[{"code":"49082","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1333.80,"maximum":1389.96,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1333.80,"methodology":"fee schedule"}]}]},{"description":"Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes ","code_information":[{"code":"G0397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":298.30,"maximum":310.86,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":310.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":310.86,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":298.30,"methodology":"fee schedule"}]}]},{"description":"Angiography, internal mammary, radiological supervision and interpretation ","code_information":[{"code":"75756","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7865.05,"maximum":8196.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7865.05,"methodology":"fee schedule"}]}]},{"description":"Application of body cast, shoulder to hips; including head, Minerva type ","code_information":[{"code":"29040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397.10,"maximum":413.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":413.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":413.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":397.10,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, posterior technique, craniocervical (occiput-C2) ","code_information":[{"code":"22590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26668.40,"maximum":27791.28,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26668.40,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; synovectomy, partial ","code_information":[{"code":"29895","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy with biopsy; metatarsophalangeal joint ","code_information":[{"code":"28052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Biopsy of vulva or perineum (separate procedure); 1 lesion ","code_information":[{"code":"56605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1045.00,"maximum":1089.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1089.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1089.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1045.00,"methodology":"fee schedule"}]}]},{"description":"Bone marrow harvesting for transplantation; allogeneic ","code_information":[{"code":"38230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2249.60,"maximum":2344.32,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2344.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2344.32,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2249.60,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of fiducial markers, single or multiple ","code_information":[{"code":"31626","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9604.50,"maximum":10008.90,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10008.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10008.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9604.50,"methodology":"fee schedule"}]}]},{"description":"Cerebrospinal fluid leakage detection and localization ","code_information":[{"code":"78650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":806.55,"maximum":840.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":840.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":840.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":806.55,"methodology":"fee schedule"}]}]},{"description":"Ciliary body destruction; cyclophotocoagulation, transscleral ","code_information":[{"code":"66710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of hip dislocation, traumatic; without anesthesia ","code_information":[{"code":"27250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of sternoclavicular dislocation; with manipulation ","code_information":[{"code":"23525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) ","code_information":[{"code":"44388","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1308.15,"maximum":1363.23,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1308.15,"methodology":"fee schedule"}]}]},{"description":"Colpopexy, vaginal; intra-peritoneal approach (uterosacral, levator myorrhaphy) ","code_information":[{"code":"57283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11196.70,"maximum":11668.14,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":11668.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":11668.14,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":11196.70,"methodology":"fee schedule"}]}]},{"description":"Comprehensive electrophysiologic evaluation with transseptal catheterizations, insertion and repositioning of multiple electrode catheters, induction or attempted induction of an arrhythmia including ","code_information":[{"code":"93656","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1836.35,"maximum":1913.67,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1913.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1913.67,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1836.35,"methodology":"fee schedule"}]}]},{"description":"Conditioning play audiometry ","code_information":[{"code":"92582","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55.10,"maximum":57.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":55.10,"methodology":"fee schedule"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method ","code_information":[{"code":"28297","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy (including ureteral catheterization); with fragmentation of ureteral calculus (eg, ultrasonic or electro-hydraulic technique) ","code_information":[{"code":"52325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7277.00,"maximum":7583.40,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7277.00,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy, forearm and/or wrist, flexor OR extensor compartment; with debridement of nonviable muscle and/or nerve ","code_information":[{"code":"25023","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Venography, superior sagittal sinus, radiological supervision and interpretation ","code_information":[{"code":"75870","type":"CPT"},{"code":"783733","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":4721.50,"maximum":4920.30,"gross_charge":3608.98,"discounted_cash":3608.98,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4721.50,"methodology":"fee schedule"}]}]},{"description":"Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device ","code_information":[{"code":"94664","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":309.70,"maximum":322.74,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":322.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":322.74,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":309.70,"methodology":"fee schedule"}]}]},{"description":"Destruction of neurofibroma, extensive (cutaneous, dermal extending into subcutaneous); trunk and extremities, extensive, greater than 100 neurofibromas ","code_information":[{"code":"0420T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":863.55,"maximum":899.91,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":863.55,"methodology":"fee schedule"}]}]},{"description":"Dilation of urethral stricture or vesical neck by passage of sound or urethral dilator, male, general or conduction (spinal) anesthesia ","code_information":[{"code":"53605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area) ","code_information":[{"code":"16020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":295.45,"maximum":307.89,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":295.45,"methodology":"fee schedule"}]}]},{"description":"Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report ","code_information":[{"code":"93005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8174.75,"maximum":8518.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8518.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8518.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8174.75,"methodology":"fee schedule"}]}]},{"description":"Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact groupºs», interleaving, amplitude, pulse width, frequency ºHz», on/off cycling, burst, magnet mode, dose locko ","code_information":[{"code":"95972","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1517.15,"maximum":1581.03,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1581.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1581.03,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1517.15,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, 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":"43270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2678.05,"maximum":2790.81,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2790.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2790.81,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2678.05,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) ","code_information":[{"code":"43232","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2678.05,"maximum":2790.81,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2790.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2790.81,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2678.05,"methodology":"fee schedule"}]}]},{"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"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Excision of lesion of tongue with closure; with local tongue flap ","code_information":[{"code":"41114","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"Excision of rectal tumor, transanal endoscopic microsurgical approach (ie, TEMS), including muscularis propria (ie, full thickness) ","code_information":[{"code":"0184T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8302.05,"maximum":8651.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8651.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8651.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8302.05,"methodology":"fee schedule"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of proximal humerus; with autograft (includes obtaining graft) ","code_information":[{"code":"23155","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Excision, ischial pressure ulcer, with primary suture; with ostectomy (ischiectomy) ","code_information":[{"code":"15941","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with ostectomy ","code_information":[{"code":"15958","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5807.35,"maximum":6051.87,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":6051.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":6051.87,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5807.35,"methodology":"fee schedule"}]}]},{"description":"Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; sublingual ","code_information":[{"code":"41015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":745.75,"maximum":777.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":777.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":777.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":745.75,"methodology":"fee schedule"}]}]},{"description":"Fine needle aspiration biopsy, including CT guidance; first lesion ","code_information":[{"code":"10009","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1026.00,"maximum":1069.20,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1026.00,"methodology":"fee schedule"}]}]},{"description":"Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes ","code_information":[{"code":"94727","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229.90,"maximum":239.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":239.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":239.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":229.90,"methodology":"fee schedule"}]}]},{"description":"Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) ","code_information":[{"code":"21235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Hospital outpatient clinic visit for assessment and management of a patient ","code_information":[{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":122.55,"maximum":127.71,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":127.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":127.71,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":122.55,"methodology":"fee schedule"}]}]},{"description":"Implantation of intravitreal drug delivery system (eg, ganciclovir implant), includes concomitant removal of vitreous ","code_information":[{"code":"67027","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":27543.35,"maximum":28703.07,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":28703.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":28703.07,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":27543.35,"methodology":"fee schedule"}]}]},{"description":"Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax; with partial rib ostectomy ","code_information":[{"code":"21502","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease ºcovid-19»), amplified probe technique, cdc or non-cdc, makin ","code_information":[{"code":"U0005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":97.85,"maximum":101.97,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":101.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":101.97,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":97.85,"methodology":"fee schedule"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; paracervical (uterine) nerve ","code_information":[{"code":"64435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1046.90,"maximum":1090.98,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1090.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1090.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1046.90,"methodology":"fee schedule"}]}]},{"description":"Injection, cabotegravir and rilpivirine, 2mg/3mg ","code_information":[{"code":"J0741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":148.20,"maximum":154.44,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":154.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":154.44,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":148.20,"methodology":"fee schedule"}]}]},{"description":"Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram ","code_information":[{"code":"Q5101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":683048.10,"maximum":711808.02,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":711808.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":711808.02,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":683048.10,"methodology":"fee schedule"}]}]},{"description":"Injection, ixabepilone, 1 mg ","code_information":[{"code":"J9207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":887.30,"maximum":924.66,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":924.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":924.66,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":887.30,"methodology":"fee schedule"}]}]},{"description":"Injection, plicamycin, 2.5 mg ","code_information":[{"code":"J9270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22.80,"maximum":23.76,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":23.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":23.76,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":22.80,"methodology":"fee schedule"}]}]},{"description":"Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial ","code_information":[{"code":"J3240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9.50,"maximum":9.90,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":9.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":9.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9.50,"methodology":"fee schedule"}]}]},{"description":"Insertion of implants into the soft palate; minimum of three implants ","code_information":[{"code":"C9727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26488.85,"maximum":27604.17,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27604.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27604.17,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26488.85,"methodology":"fee schedule"}]}]},{"description":"Insertion of substernal implantable defibrillator electrode ","code_information":[{"code":"0572T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13456.75,"maximum":14023.35,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":14023.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":14023.35,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":13456.75,"methodology":"fee schedule"}]}]},{"description":"Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify number of tests ","code_information":[{"code":"95028","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39.90,"maximum":41.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":39.90,"methodology":"fee schedule"}]}]},{"description":"Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, n ","code_information":[{"code":"M0250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1211.25,"maximum":1262.25,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1262.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1262.25,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1211.25,"methodology":"fee schedule"}]}]},{"description":"Ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s) ","code_information":[{"code":"95875","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":436.05,"maximum":454.41,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":436.05,"methodology":"fee schedule"}]}]},{"description":"LAPAROSCOPY, SURGICAL, REPAIR, INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); INCARCERATED OR STRANGULATED ","code_information":[{"code":"49655","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14689.85,"maximum":15308.37,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":14689.85,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple ","code_information":[{"code":"38570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8345.75,"maximum":8697.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8345.75,"methodology":"fee schedule"}]}]},{"description":"Leukocyte transfusion ","code_information":[{"code":"86950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55.10,"maximum":57.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":55.10,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material ","code_information":[{"code":"70551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":607.05,"maximum":632.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":607.05,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing ","code_information":[{"code":"70555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Repair nasal septal perforations ","code_information":[{"code":"30630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"Repair of nasolabial fistula ","code_information":[{"code":"42260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm ","code_information":[{"code":"12056","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":570.00,"maximum":594.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":570.00,"methodology":"fee schedule"}]}]},{"description":"Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, single, each tendon or muscle ","code_information":[{"code":"25263","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Resection of scrotum ","code_information":[{"code":"55150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Revision, lower extremity arterial bypass, without thrombectomy, open; with segmental vein interposition ","code_information":[{"code":"35881","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7865.05,"maximum":8196.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7865.05,"methodology":"fee schedule"}]}]},{"description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), olecranon process ","code_information":[{"code":"24138","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"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"}],"standard_charges":[{"setting":"outpatient","minimum":570.00,"maximum":594.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":570.00,"methodology":"fee schedule"}]}]},{"description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, b ","code_information":[{"code":"44369","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2678.05,"maximum":2790.81,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2790.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2790.81,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2678.05,"methodology":"fee schedule"}]}]},{"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"}],"standard_charges":[{"setting":"outpatient","minimum":2824.35,"maximum":2943.27,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2824.35,"methodology":"fee schedule"}]}]},{"description":"Sympathectomy, cervical ","code_information":[{"code":"64802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2895.60,"maximum":3017.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2895.60,"methodology":"fee schedule"}]}]},{"description":"Tenotomy, flexor, finger, open, each tendon ","code_information":[{"code":"26455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Therapeutic radiology simulation-aided field setting; simple ","code_information":[{"code":"77280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179.55,"maximum":187.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"Transection or avulsion of obturator nerve, intrapelvic, with or without adductor tenotomy ","code_information":[{"code":"64766","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2895.60,"maximum":3017.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2895.60,"methodology":"fee schedule"}]}]},{"description":"Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral ","code_information":[{"code":"950439","type":"CDM"},{"code":"C8929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1179.90,"maximum":1229.58,"gross_charge":3067.59,"discounted_cash":3067.59,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1229.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1229.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1179.90,"methodology":"fee schedule"}]}]},{"description":"Treatment of superficial wound dehiscence; simple closure ","code_information":[{"code":"12020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":863.55,"maximum":899.91,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":863.55,"methodology":"fee schedule"}]}]},{"description":"Ultrasound, spinal canal and contents ","code_information":[{"code":"76800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179.55,"maximum":187.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"Unlisted procedure, foot or toes ","code_information":[{"code":"28899","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Unlisted surgical pathology procedure ","code_information":[{"code":"88399","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60.80,"maximum":63.36,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":60.80,"methodology":"fee schedule"}]}]},{"description":"Venography, caval, inferior, with serialography, radiological supervision and interpretation ","code_information":[{"code":"75825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179.55,"maximum":187.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (eg, macular pucker) ","code_information":[{"code":"67041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6459.05,"maximum":6731.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":6731.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":6731.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":6459.05,"methodology":"fee schedule"}]}]},{"description":"Excision of tendon, forearm and/or wrist, flexor or extensor, each ","code_information":[{"code":"25109","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand ","code_information":[{"code":"15837","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); 5 cm or greater ","code_information":[{"code":"21933","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg, intramuscular); less than 5 cm ","code_information":[{"code":"24076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Extraction erupted tooth/exr ","code_information":[{"code":"D7140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2287.60,"maximum":2383.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2287.60,"methodology":"fee schedule"}]}]},{"description":"Fascia lata graft; by stripper ","code_information":[{"code":"20920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2824.35,"maximum":2943.27,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2824.35,"methodology":"fee schedule"}]}]},{"description":"Frenoplasty (surgical revision of frenum, eg, with Z-plasty) ","code_information":[{"code":"41520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or injury ","code_information":[{"code":"43840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8302.05,"maximum":8651.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8651.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8651.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8302.05,"methodology":"fee schedule"}]}]},{"description":"Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative measurement(s) when performed ","code_information":[{"code":"78227","type":"CPT"},{"code":"955681","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":806.55,"maximum":840.51,"gross_charge":2441.80,"discounted_cash":2441.80,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":840.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":840.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":806.55,"methodology":"fee schedule"}]}]},{"description":"Imaging of retina for detection or monitoring of disease; point-of-care autonomous analysis and report, unilateral or bilateral ","code_information":[{"code":"92229","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91.20,"maximum":95.04,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":91.20,"methodology":"fee schedule"}]}]},{"description":"Injection procedure for Peyronie disease; with surgical exposure of plaque ","code_information":[{"code":"54205","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7277.00,"maximum":7583.40,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7277.00,"methodology":"fee schedule"}]}]},{"description":"Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, i ","code_information":[{"code":"62320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1046.90,"maximum":1090.98,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1090.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1090.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1046.90,"methodology":"fee schedule"}]}]},{"description":"Injection, bendamustine hydrochloride, (belrapzo/bendamustine), 1 mg ","code_information":[{"code":"J9036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":70.30,"maximum":73.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":73.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":73.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":70.30,"methodology":"fee schedule"}]}]},{"description":"Injection, clofarabine, 1 mg ","code_information":[{"code":"J9027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":75.05,"maximum":78.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":78.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":78.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":75.05,"methodology":"fee schedule"}]}]},{"description":"Injection, golimumab, 1 mg, for intravenous use ","code_information":[{"code":"J1602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":61.75,"maximum":64.35,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":64.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":64.35,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":61.75,"methodology":"fee schedule"}]}]},{"description":"Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg ","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"944477","type":"CDM"},{"code":"J9230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":69124.85,"maximum":72035.37,"gross_charge":1140.28,"discounted_cash":1140.28,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":72035.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":72035.37,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":69124.85,"methodology":"fee schedule"}]}]},{"description":"Injection, porfimer sodium, 75 mg ","drug_information":{"unit":"75","type":"ME"},"code_information":[{"code":"942991","type":"CDM"},{"code":"J9600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":301.15,"maximum":313.83,"gross_charge":785.49,"discounted_cash":785.49,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":313.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":313.83,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":301.15,"methodology":"fee schedule"}]}]},{"description":"Injection, tirofiban hcl, 0.25 mg ","code_information":[{"code":"J3246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1.90,"maximum":1.98,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1.90,"methodology":"fee schedule"}]}]},{"description":"Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure) ","code_information":[{"code":"59200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":464.55,"maximum":484.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":484.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":484.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":464.55,"methodology":"fee schedule"}]}]},{"description":"Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse generator ","code_information":[{"code":"0408T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38034.20,"maximum":39635.64,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":39635.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":39635.64,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":38034.20,"methodology":"fee schedule"}]}]},{"description":"Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; submental space ","code_information":[{"code":"41007","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2230.60,"maximum":2324.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2230.60,"methodology":"fee schedule"}]}]},{"description":"Kidney function study, non-imaging radioisotopic study ","code_information":[{"code":"78725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":621.30,"maximum":647.46,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":621.30,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; cholecystectomy with cholangiography ","code_information":[{"code":"47563","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8345.75,"maximum":8697.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8345.75,"methodology":"fee schedule"}]}]},{"description":"Lengthening of hamstring tendon; single tendon ","code_information":[{"code":"27393","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Ligation; internal or common carotid artery ","code_information":[{"code":"37605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4721.50,"maximum":4920.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4721.50,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar ","code_information":[{"code":"72158","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance spectroscopy, determination and localization of discogenic pain (cervical, thoracic, or lumbar); acquisition of single voxel data, per disc, on biomarkers (ie, lactic acid, carbohyd ","code_information":[{"code":"0609T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Meniscectomy, partial or complete, temporomandibular joint (separate procedure) ","code_information":[{"code":"21060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Muscle, myocutaneous, or fasciocutaneous flap; upper extremity ","code_information":[{"code":"15736","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2824.35,"maximum":2943.27,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2824.35,"methodology":"fee schedule"}]}]},{"description":"Nerve conduction studies; 11-12 studies ","code_information":[{"code":"95912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":436.05,"maximum":454.41,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":436.05,"methodology":"fee schedule"}]}]},{"description":"Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of u ","code_information":[{"code":"G2082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":39.90,"maximum":41.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":39.90,"methodology":"fee schedule"}]}]},{"description":"Open treatment of coccygeal fracture ","code_information":[{"code":"27202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Open treatment of scapular fracture (body, glenoid or acromion) includes internal fixation, when performed ","code_information":[{"code":"23585","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of lesion ","code_information":[{"code":"67412","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Osteoplasty, radius AND ulna; shortening (excluding 64876) ","code_information":[{"code":"25392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion ","code_information":[{"code":"11055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":295.45,"maximum":307.89,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":295.45,"methodology":"fee schedule"}]}]},{"description":"Patient-initiated spirometric recording per 30-day period of time; recording (includes hook-up, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration) ","code_information":[{"code":"94015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229.90,"maximum":239.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":239.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":239.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":229.90,"methodology":"fee schedule"}]}]},{"description":"Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) ","code_information":[{"code":"27447","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14000.00,"maximum":21193.92,"payers_information":[{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_percentage":125.00,"standard_charge_algorithm":"Reimbursement will be 125% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14000.00,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"BURNS; M > 0 ","code_information":[{"code":"D2101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21865.10,"maximum":22991.69,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22991.69,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22991.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22991.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22991.69,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22991.69,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22991.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":21865.10,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M < 31.15 ","code_information":[{"code":"D1404","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":30052.80,"maximum":31601.26,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":31601.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":31601.26,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":31601.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":31601.26,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":31601.26,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":31601.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":30052.80,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M > 38.55 & M < 48.85 ","code_information":[{"code":"D1402","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20044.76,"maximum":21077.56,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":21077.56,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":21077.56,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":21077.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":21077.56,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":21077.56,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":21077.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":20044.76,"methodology":"fee schedule"}]}]},{"description":"EXPIRED, ORTHOPEDIC, LENGTH OF STAY IS 13 DAYS OR ","code_information":[{"code":"A5101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14382.97,"maximum":15124.05,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":15124.05,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":15124.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":15124.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":15124.05,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":15124.05,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":15124.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14382.97,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 28.15 & M < 34.15 ","code_information":[{"code":"C0703","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28178.92,"maximum":29630.83,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":29630.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":29630.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":29630.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":29630.83,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":29630.83,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":29630.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":28178.92,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 42.15 ","code_information":[{"code":"C0701","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18551.39,"maximum":19507.25,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18551.39,"methodology":"fee schedule"}]}]},{"description":"GUILLIAN BARRE; M > 18.05 & M < 35.95 ","code_information":[{"code":"C1902","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24469.41,"maximum":25730.18,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":25730.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":25730.18,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":25730.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":25730.18,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":25730.18,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":25730.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":24469.41,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA NO BRAIN OR SPINAL CORD INJURY; M ","code_information":[{"code":"B1702","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31764.15,"maximum":33400.78,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":33400.78,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":33400.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":33400.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":33400.78,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":33400.78,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":33400.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":31764.15,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA W BRAIN OR SPINAL CORD INJURY; M > ","code_information":[{"code":"C1802","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21698.74,"maximum":22816.76,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22816.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22816.76,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22816.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22816.76,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22816.76,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22816.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":21698.74,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CODE IN ","code_information":[{"code":"C1804","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":30486.85,"maximum":32057.67,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":32057.67,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":32057.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":32057.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":32057.67,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":32057.67,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":32057.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":30486.85,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CORD IN ","code_information":[{"code":"D1801","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15354.33,"maximum":16145.45,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16145.45,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16145.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16145.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16145.45,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16145.45,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16145.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15354.33,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M < 27.85 ","code_information":[{"code":"C2004","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32184.81,"maximum":33843.12,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":33843.12,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":33843.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":33843.12,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":33843.12,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":33843.12,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":33843.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":32184.81,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 38.75 & M < 49.15 ","code_information":[{"code":"C2002","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22478.89,"maximum":23637.11,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":23637.11,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":23637.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":23637.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":23637.11,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":23637.11,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":23637.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22478.89,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M=12-32 AND A tm81 ","code_information":[{"code":"C2005","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":33924.84,"maximum":35672.81,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":35672.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":35672.81,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":35672.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":35672.81,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":35672.81,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":35672.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":33924.84,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 25.85 & M < 37.35 ","code_information":[{"code":"C0603","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28427.49,"maximum":29892.21,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":29892.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":29892.21,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":29892.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":29892.21,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":29892.21,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":29892.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":28427.49,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 47.75 ","code_information":[{"code":"C0601","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19021.77,"maximum":20001.87,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19021.77,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 26.15 & M < 35.05 ","code_information":[{"code":"C0303","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28526.93,"maximum":29996.77,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":29996.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":29996.77,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":29996.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":29996.77,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":29996.77,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":29996.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":28526.93,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 41.05 ","code_information":[{"code":"C0301","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18337.24,"maximum":19282.06,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":19282.06,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":19282.06,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":19282.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":19282.06,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":19282.06,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":19282.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18337.24,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 29.25 & M < 3 ","code_information":[{"code":"C0504","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32289.98,"maximum":33953.71,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":33953.71,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":33953.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":33953.71,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":33953.71,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":33953.71,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":33953.71,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":32289.98,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 40.15 & M < 5 ","code_information":[{"code":"C0502","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23696.91,"maximum":24917.89,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":24917.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":24917.89,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":24917.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":24917.89,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":24917.89,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":24917.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":23696.91,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M < 30.75 ","code_information":[{"code":"C1203","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":30270.78,"maximum":31830.47,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":31830.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":31830.47,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":31830.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":31830.47,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":31830.47,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":31830.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":30270.78,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M > 37.65 ","code_information":[{"code":"C1201","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19300.94,"maximum":20295.42,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":20295.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":20295.42,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":20295.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":20295.42,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":20295.42,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":20295.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19300.94,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M < 24.15 ","code_information":[{"code":"C0904","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32798.60,"maximum":34488.54,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":34488.54,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":34488.54,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":34488.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34488.54,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":34488.54,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":34488.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":32798.60,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M > 34.35 & M < 44.75 ","code_information":[{"code":"C0902","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22922.50,"maximum":24103.58,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":24103.58,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":24103.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":24103.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":24103.58,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":24103.58,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":24103.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22922.50,"methodology":"fee schedule"}]}]},{"description":"PAIN SYNDROME: M < 26.75 ","code_information":[{"code":"C1603","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26909.27,"maximum":28295.76,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":28295.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":28295.76,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":28295.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":28295.76,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":28295.76,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":28295.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":26909.27,"methodology":"fee schedule"}]}]},{"description":"PAIN SYNDROME; M > 37.15 ","code_information":[{"code":"C1601","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18595.37,"maximum":19553.49,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":19553.49,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":19553.49,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":19553.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":19553.49,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":19553.49,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":19553.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18595.37,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 29.15 & M < 39.05 ","code_information":[{"code":"C1503","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28502.07,"maximum":29970.63,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":29970.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":29970.63,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":29970.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":29970.63,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":29970.63,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":29970.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":28502.07,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 49.25 ","code_information":[{"code":"C1501","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19769.41,"maximum":20788.03,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":20788.03,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":20788.03,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":20788.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":20788.03,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":20788.03,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":20788.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19769.41,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXT JOINT; M > 28.65 & M < 37 ","code_information":[{"code":"D0803","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21459.73,"maximum":22565.43,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22565.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22565.43,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22565.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22565.43,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22565.43,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22565.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":21459.73,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 37.05 & ","code_information":[{"code":"C0802","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21148.05,"maximum":22237.70,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22237.70,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22237.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22237.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22237.70,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22237.70,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22237.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":21148.05,"methodology":"fee schedule"}]}]},{"description":"Revision of total hip arthroplasty; femoral component only, with or without allograft ","code_information":[{"code":"27138","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14000.00,"maximum":21193.92,"payers_information":[{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_percentage":125.00,"standard_charge_algorithm":"Reimbursement will be 125% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14000.00,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M > 26.15 & M < 36.35 ","code_information":[{"code":"A1302","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20926.25,"maximum":22004.47,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22004.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22004.47,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22004.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22004.47,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22004.47,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22004.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":20926.25,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M=12-35 ","code_information":[{"code":"A1304","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":30066.18,"maximum":31615.33,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":30066.18,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 30.05 & M < 34.25 ","code_information":[{"code":"D0106","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":44043.78,"maximum":46313.13,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":46313.13,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":46313.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":46313.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":46313.13,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":46313.13,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":46313.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":44043.78,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 38.85 & M < 44.45 ","code_information":[{"code":"D0104","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":30966.79,"maximum":32562.35,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":32562.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":32562.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":32562.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":32562.35,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":32562.35,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":32562.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":30966.79,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 44.45 & M < 51.05 & C > 18.5 ","code_information":[{"code":"D0102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18824.83,"maximum":19794.77,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":19794.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":19794.77,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":19794.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":19794.77,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":19794.77,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":19794.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18824.83,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 28.75 & M < 40.65 ","code_information":[{"code":"D0205","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":37741.43,"maximum":39686.05,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":39686.05,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":39686.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":39686.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":39686.05,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":39686.05,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":39686.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":37741.43,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 44.25 & C < 23.5 ","code_information":[{"code":"D0203","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23756.18,"maximum":24980.22,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":24980.22,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":24980.22,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":24980.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":24980.22,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":24980.22,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":24980.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":23756.18,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 53.35 & C > 23.5 ","code_information":[{"code":"D0201","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":14587.57,"maximum":15339.19,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":15339.19,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":15339.19,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":15339.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":15339.19,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":15339.19,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":15339.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14587.57,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M < 16.05 & A > 63.5 ","code_information":[{"code":"D0404","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":50305.98,"maximum":52897.98,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":52897.98,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":52897.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":52897.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":52897.98,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":52897.98,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":52897.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":50305.98,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M > 30.35 & M < 48.4 ","code_information":[{"code":"D0402","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25674.04,"maximum":26996.89,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":26996.89,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":26996.89,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":26996.89,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":26996.89,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":26996.89,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":26996.89,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":25674.04,"methodology":"fee schedule"}]}]},{"description":" Operating Room Services Kidney Transplant  ","code_information":[{"code":"367","type":"RC"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":" Gastro-Intestinal (GI) Services General Classification  ","code_information":[{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","payers_information":[{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":" Intensive Care Unit Other Intensive Care  ","code_information":[{"code":"209","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":1700.00,"maximum":1700.00,"payers_information":[{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1700.00,"methodology":"per diem"}]}]},{"description":" Coronary Care Unit Intermediate CCU  ","code_information":[{"code":"214","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":1700.00,"maximum":1700.00,"payers_information":[{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1700.00,"methodology":"per diem"}]}]},{"description":"Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance guidance ","code_information":[{"code":"19287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1026.00,"maximum":1069.20,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1026.00,"methodology":"fee schedule"}]}]},{"description":"Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; by density gradient separation ","code_information":[{"code":"86972","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":245.10,"maximum":255.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":245.10,"methodology":"fee schedule"}]}]},{"description":"Provision of test materials and equipment for home inr monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage c ","code_information":[{"code":"G0249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":195.70,"maximum":203.94,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":203.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":203.94,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":195.70,"methodology":"fee schedule"}]}]},{"description":"Rabies vaccine, for intradermal use ","code_information":[{"code":"90676","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3164.45,"maximum":3297.69,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3297.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3297.69,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3164.45,"methodology":"fee schedule"}]}]},{"description":"Radical resection of tumor; innominate bone, total ","code_information":[{"code":"27077","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20337.60,"maximum":21193.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); minimum of 6 views ","code_information":[{"code":"72084","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133.00,"maximum":138.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":133.00,"methodology":"fee schedule"}]}]},{"description":"Radiopharmaceutical therapy, by intravenous administration ","code_information":[{"code":"79101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2154.60,"maximum":2245.32,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2245.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2245.32,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2154.60,"methodology":"fee schedule"}]}]},{"description":"Reconstruction, entire or majority of forehead and/or supraorbital rims; with grafts (allograft or prosthetic material) ","code_information":[{"code":"21179","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Removal foreign body from deep penile tissue (eg, plastic implant) ","code_information":[{"code":"54115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Removal of implantable defibrillator pulse generator only ","code_information":[{"code":"33241","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5679.10,"maximum":5918.22,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5918.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5918.22,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5679.10,"methodology":"fee schedule"}]}]},{"description":"Removal of transvenous pacemaker electrode(s); dual lead system ","code_information":[{"code":"33235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5679.10,"maximum":5918.22,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5918.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5918.22,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5679.10,"methodology":"fee schedule"}]}]},{"description":"Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) ","code_information":[{"code":"67902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5453.00,"maximum":5682.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5682.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5682.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5453.00,"methodology":"fee schedule"}]}]},{"description":"Repair of nonunion or malunion, tibia; without graft, (eg, compression technique) ","code_information":[{"code":"27720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OLDER; INCARCERATED OR STRANGULATED ","code_information":[{"code":"49587","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5246.85,"maximum":5467.77,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5246.85,"methodology":"fee schedule"}]}]},{"description":"Repair, laceration of palate; up to 2 cm ","code_information":[{"code":"42180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":745.75,"maximum":777.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":777.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":777.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":745.75,"methodology":"fee schedule"}]}]},{"description":"Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, ","code_information":[{"code":"37193","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4721.50,"maximum":4920.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4721.50,"methodology":"fee schedule"}]}]},{"description":"Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component ","code_information":[{"code":"24370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14000.00,"maximum":21193.92,"payers_information":[{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14000.00,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal humerus ","code_information":[{"code":"24134","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"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"}],"standard_charges":[{"setting":"outpatient","minimum":295.45,"maximum":307.89,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":295.45,"methodology":"fee schedule"}]}]},{"description":"Specimen collection for severe acute respiratory syndrome coronavirus  2 (sars-cov-2) (coronavirus disease ºcovid-19») from an individual in a  snf or by a laboratory on behalf of a hha, any specimen ","code_information":[{"code":"G2024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":170.05,"maximum":177.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":177.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":177.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":170.05,"methodology":"fee schedule"}]}]},{"description":"Sympathectomy; digital arteries, each digit ","code_information":[{"code":"64820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2895.60,"maximum":3017.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2895.60,"methodology":"fee schedule"}]}]},{"description":"Tenotomy, open, tendon flexor; foot, single or multiple tendon(s) (separate procedure) ","code_information":[{"code":"28230","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Thrombectomy of arterial or venous graft (other than hemodialysis graft or fistula); with revision of arterial or venous graft ","code_information":[{"code":"35876","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7865.05,"maximum":8196.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7865.05,"methodology":"fee schedule"}]}]},{"description":"Tracheostoma revision; complex, with flap rotation ","code_information":[{"code":"31614","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Transcranial Doppler study of the intracranial arteries; vasoreactivity study ","code_information":[{"code":"93890","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Transitional care management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge ","code_information":[{"code":"99495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":220.40,"maximum":229.68,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":229.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":229.68,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":220.40,"methodology":"fee schedule"}]}]},{"description":"Treatment of missed abortion, completed surgically; second trimester ","code_information":[{"code":"59821","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4327.25,"maximum":4509.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4327.25,"methodology":"fee schedule"}]}]},{"description":"Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation ","code_information":[{"code":"76811","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179.55,"maximum":187.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine ","code_information":[{"code":"78199","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":621.30,"maximum":647.46,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":621.30,"methodology":"fee schedule"}]}]},{"description":"Unlisted procedure, abdomen, musculoskeletal system ","code_information":[{"code":"22999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Unlisted procedure, humerus or elbow ","code_information":[{"code":"24999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Urethrocystography, voiding, radiological supervision and interpretation ","code_information":[{"code":"74455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":607.05,"maximum":632.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":607.05,"methodology":"fee schedule"}]}]},{"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"}],"standard_charges":[{"setting":"outpatient","minimum":16567.05,"maximum":17264.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":17264.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":17264.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":16567.05,"methodology":"fee schedule"}]}]},{"description":"Vestibuloplasty; entire arch ","code_information":[{"code":"40844","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Ablation, 1 or more liver tumor(s), percutaneous, radiofrequency ","code_information":[{"code":"47382","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8345.75,"maximum":8697.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8345.75,"methodology":"fee schedule"}]}]},{"description":"Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours or longer; recording only ","code_information":[{"code":"93786","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450.30,"maximum":469.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":469.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":469.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":450.30,"methodology":"fee schedule"}]}]},{"description":"Ankle disarticulation ","code_information":[{"code":"27889","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Application of clubfoot cast with molding or manipulation, long or short leg ","code_information":[{"code":"29450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":232.75,"maximum":242.55,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":242.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":242.55,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":232.75,"methodology":"fee schedule"}]}]},{"description":"Arteriovenous anastomosis, open; by upper arm cephalic vein transposition ","code_information":[{"code":"36818","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7865.05,"maximum":8196.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7865.05,"methodology":"fee schedule"}]}]},{"description":"Arthroplasty, metacarpophalangeal joint; with prosthetic implant, each joint ","code_information":[{"code":"26531","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral) ","code_information":[{"code":"29882","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy, with synovectomy, ankle; ","code_information":[{"code":"27625","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance ","code_information":[{"code":"55706","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Biopsy, oocyte polar body or embryo blastomere, microtechnique (for pre-implantation genetic diagnosis); greater than 5 embryos ","code_information":[{"code":"89291","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1080.15,"maximum":1125.63,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1125.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1125.63,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1080.15,"methodology":"fee schedule"}]}]},{"description":"Bone graft, any donor area; major or large ","code_information":[{"code":"20902","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Brachytherapy source, stranded, not otherwise specified, per source ","code_information":[{"code":"C2698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":114.00,"maximum":118.80,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":118.80,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":118.80,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":114.00,"methodology":"fee schedule"}]}]},{"description":"Capsaicin 8% patch, per square centimeter ","code_information":[{"code":"J7336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1242.60,"maximum":1294.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1294.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1294.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1242.60,"methodology":"fee schedule"}]}]},{"description":"Cardioversion, elective, electrical conversion of arrhythmia; internal (separate procedure) ","code_information":[{"code":"92961","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16567.05,"maximum":17264.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":17264.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":17264.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":16567.05,"methodology":"fee schedule"}]}]},{"description":"Chemodenervation of eccrine glands; both axillae ","code_information":[{"code":"64650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":430.35,"maximum":448.47,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":448.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":448.47,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":430.35,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of acetabulum (hip socket) fracture(s); without manipulation ","code_information":[{"code":"27220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of humeral condylar fracture, medial or lateral; with manipulation ","code_information":[{"code":"24577","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia ","code_information":[{"code":"28540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy through stoma; with removal of foreign body(s) ","code_information":[{"code":"44390","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1308.15,"maximum":1363.23,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1308.15,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, soft tissue neck; without contrast material ","code_information":[{"code":"70490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":294.50,"maximum":306.90,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":306.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":306.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":294.50,"methodology":"fee schedule"}]}]},{"description":"Creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, single or multiple stages; globus pallidus or thalamus ","code_information":[{"code":"61720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9405.00,"maximum":9801.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9405.00,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants ","code_information":[{"code":"C9740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2082.40,"maximum":2170.08,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2170.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2170.08,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2082.40,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy, leg; anterior and/or lateral compartments only, with debridement of nonviable muscle and/or nerve ","code_information":[{"code":"27892","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale under radiologic monitoring ","code_information":[{"code":"64610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2895.60,"maximum":3017.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2895.60,"methodology":"fee schedule"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less ","code_information":[{"code":"17280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":295.45,"maximum":307.89,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":295.45,"methodology":"fee schedule"}]}]},{"description":"Drainage abscess or hematoma, nasal, internal approach ","code_information":[{"code":"30000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":348.65,"maximum":363.33,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":363.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":363.33,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":348.65,"methodology":"fee schedule"}]}]},{"description":"Drug assay, definitive, 80 or more drugs or metabolites, urine, by quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or me ","code_information":[{"code":"0146U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":313.50,"maximum":326.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":326.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":326.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":313.50,"methodology":"fee schedule"}]}]},{"description":"Electroejaculation ","code_information":[{"code":"55870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1045.00,"maximum":1089.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1089.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1089.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1045.00,"methodology":"fee schedule"}]}]},{"description":"Embolectomy or thrombectomy, with or without catheter; radial or ulnar artery, by arm incision ","code_information":[{"code":"34111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7865.05,"maximum":8196.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7865.05,"methodology":"fee schedule"}]}]},{"description":"Epididymectomy; unilateral ","code_information":[{"code":"54860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed ","code_information":[{"code":"43210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14689.85,"maximum":15308.37,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":14689.85,"methodology":"fee schedule"}]}]},{"description":"Excision of chalazion; multiple, same lid ","code_information":[{"code":"67801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1335.70,"maximum":1391.94,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1391.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1391.94,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1335.70,"methodology":"fee schedule"}]}]},{"description":"Excision of neuroma; digital nerve, 1 or both, same digit ","code_information":[{"code":"64776","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2895.60,"maximum":3017.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2895.60,"methodology":"fee schedule"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; with autograft (includes obtaining graft) ","code_information":[{"code":"24125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Excision or surgical planing of skin of nose for rhinophyma ","code_information":[{"code":"30120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cm ","code_information":[{"code":"11444","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2319.90,"maximum":2417.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2319.90,"methodology":"fee schedule"}]}]},{"description":"Exploration for undescended testis with abdominal exploration ","code_information":[{"code":"54560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2952.60,"maximum":3076.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3076.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3076.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2952.60,"methodology":"fee schedule"}]}]},{"description":"Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth; masticator space ","code_information":[{"code":"41018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2230.60,"maximum":2324.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2230.60,"methodology":"fee schedule"}]}]},{"description":"Fitting of spectacle prosthesis for aphakia; monofocal ","code_information":[{"code":"92352","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit ","code_information":[{"code":"78265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":621.30,"maximum":647.46,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":621.30,"methodology":"fee schedule"}]}]},{"description":"Hemorrhoidectomy, internal and external, 2 or more columns/groups; with fistulectomy, including fissurectomy, when performed ","code_information":[{"code":"46262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4028.95,"maximum":4198.59,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4028.95,"methodology":"fee schedule"}]}]},{"description":"Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C ","code_information":[{"code":"58558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4327.25,"maximum":4509.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4327.25,"methodology":"fee schedule"}]}]},{"description":"Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure) ","code_information":[{"code":"46040","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1710.00,"maximum":1782.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1782.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1782.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1710.00,"methodology":"fee schedule"}]}]},{"description":"Incision, drainage of lacrimal gland ","code_information":[{"code":"68400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) ","code_information":[{"code":"20552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":430.35,"maximum":448.47,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":448.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":448.47,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":430.35,"methodology":"fee schedule"}]}]},{"description":"Injection, brentuximab vedotin, 1 mg ","code_information":[{"code":"J9042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":34.20,"maximum":35.64,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":34.20,"methodology":"fee schedule"}]}]},{"description":"Injection, ecallantide, 1 mg ","code_information":[{"code":"J1290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6938.80,"maximum":7230.96,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7230.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7230.96,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":6938.80,"methodology":"fee schedule"}]}]},{"description":"Injection, hemin, 1 mg ","code_information":[{"code":"J1640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":273.60,"maximum":285.12,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":285.12,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":285.12,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":273.60,"methodology":"fee schedule"}]}]},{"description":"Injection, meropenem and vaborbactam, 10mg/10mg (20mg) ","code_information":[{"code":"J2186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3.80,"maximum":3.96,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3.96,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3.80,"methodology":"fee schedule"}]}]},{"description":"Injection, reteplase, 18.1 mg ","code_information":[{"code":"J2993","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":86.45,"maximum":90.09,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":90.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":90.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":86.45,"methodology":"fee schedule"}]}]},{"description":"Insertion of pin-retained palatal prosthesis ","code_information":[{"code":"42281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Insertion, subcutaneous cardiac rhythm monitor, including programming ","code_information":[{"code":"33285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13456.75,"maximum":14023.35,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":14023.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":14023.35,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":13456.75,"methodology":"fee schedule"}]}]},{"description":"Intraventricular pacing ","code_information":[{"code":"93612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10025.35,"maximum":10447.47,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10447.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10447.47,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10025.35,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed ","code_information":[{"code":"55866","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14689.85,"maximum":15308.37,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":14689.85,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; urethral suspension for stress incontinence ","code_information":[{"code":"51990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8345.75,"maximum":8697.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8345.75,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, flexible; with removal of lesion(s), non-laser ","code_information":[{"code":"31578","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5109.10,"maximum":5324.22,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5324.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5324.22,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5109.10,"methodology":"fee schedule"}]}]},{"description":"Lisocabtagene maraleucel, up to 110 million autologous anti-cd19 car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose ","code_information":[{"code":"Q2054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":85460.10,"maximum":89058.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":89058.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":89058.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":85460.10,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography without contrast, chest (excluding myocardium) ","code_information":[{"code":"C8910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":607.05,"maximum":632.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":607.05,"methodology":"fee schedule"}]}]},{"description":"Multiple-family group psychotherapy ","code_information":[{"code":"90849","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":220.40,"maximum":229.68,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":229.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":229.68,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":220.40,"methodology":"fee schedule"}]}]},{"description":"Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 g or less and/or removal of surface myomas; vaginal approach ","code_information":[{"code":"58145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4327.25,"maximum":4509.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4327.25,"methodology":"fee schedule"}]}]},{"description":"Neuroplasty; nerve of hand or foot ","code_information":[{"code":"64704","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2895.60,"maximum":3017.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2895.60,"methodology":"fee schedule"}]}]},{"description":"Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation ","code_information":[{"code":"25607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"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":"92018","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195.70,"maximum":203.94,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":203.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":203.94,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":195.70,"methodology":"fee schedule"}]}]},{"description":"Orchiectomy, partial ","code_information":[{"code":"54522","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Oxygen uptake, expired gas analysis; rest and exercise, direct, simple ","code_information":[{"code":"94680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":309.70,"maximum":322.74,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":322.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":322.74,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":309.70,"methodology":"fee schedule"}]}]},{"description":"Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), radial head or neck ","code_information":[{"code":"24145","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Percutaneous skeletal fixation of interphalangeal joint dislocation, single, with manipulation ","code_information":[{"code":"26776","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; cervical ","code_information":[{"code":"0219T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20337.60,"maximum":21193.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm ","code_information":[{"code":"14301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5807.35,"maximum":6051.87,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":6051.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":6051.87,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5807.35,"methodology":"fee schedule"}]}]},{"description":"Amputation, leg, through tibia and fibula; re-amputation ","code_information":[{"code":"27886","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Anoscopy; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique ","code_information":[{"code":"46615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4028.95,"maximum":4198.59,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4028.95,"methodology":"fee schedule"}]}]},{"description":"Application, cast; figure-of-eight ","code_information":[{"code":"29049","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397.10,"maximum":413.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":413.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":413.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":397.10,"methodology":"fee schedule"}]}]},{"description":"Arthroplasty, temporomandibular joint, with prosthetic joint replacement ","code_information":[{"code":"21243","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26668.40,"maximum":27791.28,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26668.40,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum ","code_information":[{"code":"29862","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Autologous platelet rich plasma (prp) or other blood-derived product for diabetic chronic wounds/ulcers, using an fda-cleared device for this indication, (includes as applicable administration, dressi ","code_information":[{"code":"G0465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":122.55,"maximum":127.71,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":127.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":127.71,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":122.55,"methodology":"fee schedule"}]}]},{"description":"Biopsy, vertebral body, open; lumbar or cervical ","code_information":[{"code":"20251","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Brachytherapy source, non-stranded, high activity, iodine-125, greater than 1.01 mci (nist), per source ","code_information":[{"code":"C2634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":995.60,"maximum":1037.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1037.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1037.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":995.60,"methodology":"fee schedule"}]}]},{"description":"Catheter aspiration (separate procedure); nasotracheal ","code_information":[{"code":"31720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":309.70,"maximum":322.74,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":322.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":322.74,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":309.70,"methodology":"fee schedule"}]}]},{"description":"Chemotherapy administration, intra-arterial; infusion technique, each additional hour (List separately in addition to code for primary procedure) ","code_information":[{"code":"96423","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":525.35,"maximum":547.47,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":547.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":547.47,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":525.35,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of carpal bone fracture (excluding carpal scaphoid ºnavicular»); with manipulation, each bone ","code_information":[{"code":"25635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of nasal bone fracture with manipulation; without stabilization ","code_information":[{"code":"21315","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2230.60,"maximum":2324.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2230.60,"methodology":"fee schedule"}]}]},{"description":"Closure of gastrostomy, surgical ","code_information":[{"code":"43870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5064.45,"maximum":5277.69,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5064.45,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy, 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":"45388","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1710.00,"maximum":1782.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1782.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1782.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1710.00,"methodology":"fee schedule"}]}]},{"description":"Commissure splint ","code_information":[{"code":"D5987","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2287.60,"maximum":2383.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2287.60,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material, followed by contrast material(s) and further sections ","code_information":[{"code":"70482","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":294.50,"maximum":306.90,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":306.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":306.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":294.50,"methodology":"fee schedule"}]}]},{"description":"Consultation, comprehensive, with review of records and specimens, with report on referred material ","code_information":[{"code":"88325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55.10,"maximum":57.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":55.10,"methodology":"fee schedule"}]}]},{"description":"Cryopreservation; embryo(s) ","code_information":[{"code":"89258","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":245.10,"maximum":255.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":245.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with injection(s) for chemodenervation of the bladder ","code_information":[{"code":"52287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2952.60,"maximum":3076.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3076.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3076.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2952.60,"methodology":"fee schedule"}]}]},{"description":"Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); ","code_information":[{"code":"59612","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4327.25,"maximum":4509.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4327.25,"methodology":"fee schedule"}]}]},{"description":"Vestibuloplasty; posterior, unilateral ","code_information":[{"code":"40842","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm ","code_information":[{"code":"17107","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":863.55,"maximum":899.91,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":863.55,"methodology":"fee schedule"}]}]},{"description":"Diagnostic bone marrow; biopsy(ies) ","code_information":[{"code":"38221","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2319.90,"maximum":2417.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2319.90,"methodology":"fee schedule"}]}]},{"description":"Drainage of abscess, cyst, hematoma, vestibule of mouth; complicated ","code_information":[{"code":"40801","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":745.75,"maximum":777.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":777.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":777.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":745.75,"methodology":"fee schedule"}]}]},{"description":"Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study ","code_information":[{"code":"93975","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Electroencephalogram (EEG), without video, review of data, technical description by EEG technologist, each increment of 12-26 hours; with continuous, real-time monitoring and maintenance ","code_information":[{"code":"779049","type":"CDM"},{"code":"95710","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":436.05,"maximum":454.41,"gross_charge":1456.65,"discounted_cash":1456.65,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":436.05,"methodology":"fee schedule"}]}]},{"description":"Endoscopic evaluation of small intestinal pouch (eg, Kock pouch, ileal reservoir ºS or J»); with biopsy, single or multiple ","code_information":[{"code":"44386","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1308.15,"maximum":1363.23,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1308.15,"methodology":"fee schedule"}]}]},{"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"}],"standard_charges":[{"setting":"outpatient","minimum":2678.05,"maximum":2790.81,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2790.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2790.81,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2678.05,"methodology":"fee schedule"}]}]},{"description":"Excision aural glomus tumor; transcanal ","code_information":[{"code":"69550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Excision of extensor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod ","code_information":[{"code":"26415","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Excision of malignant tumor of mandible; ","code_information":[{"code":"21044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Excision of varicocele or ligation of spermatic veins for varicocele; abdominal approach ","code_information":[{"code":"55535","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5246.85,"maximum":5467.77,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5246.85,"methodology":"fee schedule"}]}]},{"description":"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less ","code_information":[{"code":"11400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1026.00,"maximum":1069.20,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1026.00,"methodology":"fee schedule"}]}]},{"description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm ","code_information":[{"code":"11604","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1026.00,"maximum":1069.20,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1026.00,"methodology":"fee schedule"}]}]},{"description":"Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; 3 cm or greater ","code_information":[{"code":"27043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram ","drug_information":{"unit":"1","type":"GM"},"code_information":[{"code":"935754","type":"CDM"},{"code":"J7189","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1.90,"maximum":1.98,"gross_charge":23376.25,"discounted_cash":23376.25,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1.90,"methodology":"fee schedule"}]}]},{"description":"Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic resonance (mr) guidance ","code_information":[{"code":"C9734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1308.15,"maximum":1363.23,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1308.15,"methodology":"fee schedule"}]}]},{"description":"Gastric restrictive procedure, open; removal and replacement of subcutaneous port component only ","code_information":[{"code":"43888","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5807.35,"maximum":6051.87,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":6051.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":6051.87,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5807.35,"methodology":"fee schedule"}]}]},{"description":"Hematopoietic progenitor cell (HPC); autologous transplantation ","code_information":[{"code":"38241","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2249.60,"maximum":2344.32,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2344.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2344.32,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2249.60,"methodology":"fee schedule"}]}]},{"description":"Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) ","code_information":[{"code":"90471","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":361.00,"maximum":376.20,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":376.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":376.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":361.00,"methodology":"fee schedule"}]}]},{"description":"Incision and drainage of deep supralevator, pelvirectal, or retrorectal abscess ","code_information":[{"code":"45020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4028.95,"maximum":4198.59,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4028.95,"methodology":"fee schedule"}]}]},{"description":"Incision of labial frenum (frenotomy) ","code_information":[{"code":"40806","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":745.75,"maximum":777.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":777.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":777.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":745.75,"methodology":"fee schedule"}]}]},{"description":"Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) ","code_information":[{"code":"G0245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":621.30,"maximum":647.46,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":621.30,"methodology":"fee schedule"}]}]},{"description":"Injection, anifrolumab-fnia, 1 mg ","code_information":[{"code":"J0491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":289.75,"maximum":301.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":301.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":301.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":289.75,"methodology":"fee schedule"}]}]},{"description":"Injection, enzyme (eg, collagenase), palmar fascial cord (ie, Dupuytren's contracture) ","code_information":[{"code":"20527","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":430.35,"maximum":448.47,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":448.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":448.47,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":430.35,"methodology":"fee schedule"}]}]},{"description":"Injection, immune globulin (xembify), 100 mg ","code_information":[{"code":"J1558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":778.05,"maximum":810.81,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":810.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":810.81,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":778.05,"methodology":"fee schedule"}]}]},{"description":"Injection, olanzapine, long-acting, 1 mg ","code_information":[{"code":"J2358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1812.60,"maximum":1888.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1888.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1888.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1812.60,"methodology":"fee schedule"}]}]},{"description":"Injection, romidepsin, lyophilized, 0.1 mg ","code_information":[{"code":"J9319","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":37.05,"maximum":38.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":37.05,"methodology":"fee schedule"}]}]},{"description":"Injection, ziv-aflibercept, 1 mg ","code_information":[{"code":"J9400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":38.95,"maximum":40.59,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":38.95,"methodology":"fee schedule"}]}]},{"description":"Insertion of ocular implant secondary; after evisceration, in scleral shell ","code_information":[{"code":"65130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5453.00,"maximum":5682.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5682.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5682.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5453.00,"methodology":"fee schedule"}]}]},{"description":"Instillation(s) of therapeutic agent into renal pelvis and/or ureter through established nephrostomy, pyelostomy or ureterostomy tube (eg, anticarcinogenic or antifungal agent) ","code_information":[{"code":"50391","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":438.90,"maximum":457.38,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":457.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":457.38,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":438.90,"methodology":"fee schedule"}]}]},{"description":"Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses ","code_information":[{"code":"M0240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":242.25,"maximum":252.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":252.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":242.25,"methodology":"fee schedule"}]}]},{"description":"Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie ","code_information":[{"code":"A9517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":195.70,"maximum":203.94,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":203.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":203.94,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":195.70,"methodology":"fee schedule"}]}]},{"description":"Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; thoracic ","code_information":[{"code":"63016","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; sling operation for stress incontinence (eg, fascia or synthetic) ","code_information":[{"code":"51992","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8345.75,"maximum":8697.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8345.75,"methodology":"fee schedule"}]}]},{"description":"Laser vaporization of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transuret ","code_information":[{"code":"52648","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7277.00,"maximum":7583.40,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7277.00,"methodology":"fee schedule"}]}]},{"description":"Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (less than 2.5 cm) ","code_information":[{"code":"52317","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s) ","code_information":[{"code":"72142","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179.55,"maximum":187.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"Measurement of ocular blood flow by repetitive intraocular pressure sampling, with interpretation and report ","code_information":[{"code":"0198T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Repair of defect with autograft; radius OR ulna ","code_information":[{"code":"25425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); secondary, with free graft (includes obtaining graft), each tendon ","code_information":[{"code":"26358","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Repair, primary, disrupted ligament, ankle; both collateral ligaments ","code_information":[{"code":"27696","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access, including all imaging guidance, image documentation, an ","code_information":[{"code":"36584","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2318.95,"maximum":2416.59,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2416.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2416.59,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2318.95,"methodology":"fee schedule"}]}]},{"description":"Revision of colostomy; complicated (reconstruction in-depth) (separate procedure) ","code_information":[{"code":"44345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5246.85,"maximum":5467.77,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5246.85,"methodology":"fee schedule"}]}]},{"description":"Scrotoplasty; complicated ","code_information":[{"code":"55180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7277.00,"maximum":7583.40,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7277.00,"methodology":"fee schedule"}]}]},{"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"}],"standard_charges":[{"setting":"outpatient","minimum":295.45,"maximum":307.89,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":295.45,"methodology":"fee schedule"}]}]},{"description":"Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (eg, by airflow or peripheral arterial tone), and sleep time ","code_information":[{"code":"95800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":804.65,"maximum":838.53,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":838.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":838.53,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":804.65,"methodology":"fee schedule"}]}]},{"description":"Split-thickness 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 (except ","code_information":[{"code":"15120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5807.35,"maximum":6051.87,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":6051.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":6051.87,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5807.35,"methodology":"fee schedule"}]}]},{"description":"Suture of digital nerve, hand or foot; 1 nerve ","code_information":[{"code":"64831","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2895.60,"maximum":3017.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2895.60,"methodology":"fee schedule"}]}]},{"description":"Synovectomy; intertarsal or tarsometatarsal joint, each ","code_information":[{"code":"28070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Tenotomy, open, hamstring, knee to hip; multiple tendons, bilateral ","code_information":[{"code":"27392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Trabecular bone score (TBS), structural condition of the bone microarchitecture; technical calculation only ","code_information":[{"code":"77091","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Transfusion, blood or blood components ","code_information":[{"code":"36430","type":"CPT"},{"code":"948207","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":654.55,"maximum":682.11,"gross_charge":4073.85,"discounted_cash":4073.85,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":682.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":682.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":654.55,"methodology":"fee schedule"}]}]},{"description":"Treatment of closed elbow dislocation; without anesthesia ","code_information":[{"code":"24600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicu ","code_information":[{"code":"69633","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2230.60,"maximum":2324.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2230.60,"methodology":"fee schedule"}]}]},{"description":"Unlisted musculoskeletal procedure, head ","code_information":[{"code":"21499","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":348.65,"maximum":363.33,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":363.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":363.33,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":348.65,"methodology":"fee schedule"}]}]},{"description":"Unlisted procedure, nose ","code_information":[{"code":"30999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":348.65,"maximum":363.33,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":363.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":363.33,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":348.65,"methodology":"fee schedule"}]}]},{"description":"Vaginal hysterectomy, for uterus 250 g or less; ","code_information":[{"code":"58260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7272.25,"maximum":7578.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7578.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7578.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7272.25,"methodology":"fee schedule"}]}]},{"description":"Vermilionectomy (lip shave), with mucosal advancement ","code_information":[{"code":"40500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"Wheelchair management (eg, assessment, fitting, training), each 15 minutes ","code_information":[{"code":"903964","type":"CDM"},{"code":"97542","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42.75,"maximum":44.55,"gross_charge":306.40,"discounted_cash":306.40,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":42.75,"methodology":"fee schedule"}]}]},{"description":"Excision or fulguration of carcinoma of urethra ","code_information":[{"code":"53220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0 cm ","code_information":[{"code":"11601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1026.00,"maximum":1069.20,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1026.00,"methodology":"fee schedule"}]}]},{"description":"Excision, tumor, soft tissue of shoulder area, subcutaneous; 3 cm or greater ","code_information":[{"code":"23071","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2319.90,"maximum":2417.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2319.90,"methodology":"fee schedule"}]}]},{"description":"External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attende ","code_information":[{"code":"93271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified ","code_information":[{"code":"J7192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1.90,"maximum":1.98,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1.90,"methodology":"fee schedule"}]}]},{"description":"Fitting of spectacle prosthesis for aphakia; multifocal ","code_information":[{"code":"92353","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55.10,"maximum":57.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":55.10,"methodology":"fee schedule"}]}]},{"description":"Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days ","code_information":[{"code":"78266","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":621.30,"maximum":647.46,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":621.30,"methodology":"fee schedule"}]}]},{"description":"Hematology (hematolymphoid neoplasia), gene rearrangement detection by whole genome next-generation sequencing, DNA, whole blood or bone marrow, report of specific gene rearrangement(s) ","code_information":[{"code":"0014U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6906.50,"maximum":7197.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7197.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7197.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":6906.50,"methodology":"fee schedule"}]}]},{"description":"Hysteroscopy, surgical; with division or resection of intrauterine septum (any method) ","code_information":[{"code":"58560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7272.25,"maximum":7578.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7578.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7578.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7272.25,"methodology":"fee schedule"}]}]},{"description":"Incision and drainage, shoulder area; deep abscess or hematoma ","code_information":[{"code":"23030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; ilioinguinal, iliohypogastric nerves ","code_information":[{"code":"64425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1046.90,"maximum":1090.98,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1090.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1090.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1046.90,"methodology":"fee schedule"}]}]},{"description":"Injection, aprepitant, 1 mg ","code_information":[{"code":"J0185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8.55,"maximum":8.91,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8.91,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8.55,"methodology":"fee schedule"}]}]},{"description":"Injection, carfilzomib, 1 mg ","code_information":[{"code":"J9047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":71.25,"maximum":74.25,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":74.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":74.25,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":71.25,"methodology":"fee schedule"}]}]},{"description":"Injection, epidural, of blood or clot patch ","code_information":[{"code":"62273","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1046.90,"maximum":1090.98,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1090.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1090.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1046.90,"methodology":"fee schedule"}]}]},{"description":"Injection, immune globulin (cuvitru), 100 mg ","code_information":[{"code":"J1555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":665.00,"maximum":693.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":693.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":693.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":665.00,"methodology":"fee schedule"}]}]},{"description":"Injection, olaratumab, 10 mg ","code_information":[{"code":"J9285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":346.75,"maximum":361.35,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":361.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":361.35,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":346.75,"methodology":"fee schedule"}]}]},{"description":"Injection, rituximab-abbs, biosimilar, (truxima), 10 mg ","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"779291","type":"CDM"},{"code":"Q5115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":295.45,"maximum":307.89,"gross_charge":263.25,"discounted_cash":263.25,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":295.45,"methodology":"fee schedule"}]}]},{"description":"Injection, von willebrand factor complex (humate-p), per iu vwf:rco ","code_information":[{"code":"J7187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1.90,"maximum":1.98,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1.90,"methodology":"fee schedule"}]}]},{"description":"Insertion of ocular implant secondary; after enucleation, muscles attached to implant ","code_information":[{"code":"65140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5453.00,"maximum":5682.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5682.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5682.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5453.00,"methodology":"fee schedule"}]}]},{"description":"Intracavitary radiation source application; simple ","code_information":[{"code":"77761","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":894.90,"maximum":932.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":932.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":932.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":894.90,"methodology":"fee schedule"}]}]},{"description":"Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contras ","code_information":[{"code":"36903","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16567.05,"maximum":17264.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":17264.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":17264.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":16567.05,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only ","code_information":[{"code":"43773","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8345.75,"maximum":8697.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8345.75,"methodology":"fee schedule"}]}]},{"description":"Laryngoplasty; for laryngeal stenosis, with graft, with indwelling stent placement, age 12 years or older ","code_information":[{"code":"31554","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) ","code_information":[{"code":"37780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4721.50,"maximum":4920.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4721.50,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s) ","code_information":[{"code":"70552","type":"CPT"},{"code":"936731","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"gross_charge":5910.69,"discounted_cash":5910.69,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, head; with contrast material(s) ","code_information":[{"code":"70545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Measurement of spirometric forced expiratory flows, before and after bronchodilator, in an infant or child through 2 years of age ","code_information":[{"code":"94012","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":802.75,"maximum":836.55,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":836.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":836.55,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":802.75,"methodology":"fee schedule"}]}]},{"description":"Morphometric analysis; tumor (eg, DNA ploidy) ","code_information":[{"code":"88358","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":479.75,"maximum":499.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":479.75,"methodology":"fee schedule"}]}]},{"description":"Nasal function studies (eg, rhinomanometry) ","code_information":[{"code":"92512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91.20,"maximum":95.04,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":91.20,"methodology":"fee schedule"}]}]},{"description":"Nerve pedicle transfer; first stage ","code_information":[{"code":"64905","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9405.00,"maximum":9801.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9405.00,"methodology":"fee schedule"}]}]},{"description":"Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft) ","code_information":[{"code":"28420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20337.60,"maximum":21193.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Open treatment of fracture of orbit, except blowout; with implant ","code_information":[{"code":"21407","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Oral antral fistula closure ","code_information":[{"code":"D7260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2287.60,"maximum":2383.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2287.60,"methodology":"fee schedule"}]}]},{"description":"Osteochondral autograft(s), knee, open (eg, mosaicplasty) (includes harvesting of autograftºs») ","code_information":[{"code":"27416","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Osteotomy, humerus, with or without internal fixation ","code_information":[{"code":"24400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus ","code_information":[{"code":"28120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation ","code_information":[{"code":"26650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during cours ","code_information":[{"code":"37188","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4721.50,"maximum":4920.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4721.50,"methodology":"fee schedule"}]}]},{"description":"Physician or other qualified health care professional services for outpatient pulmonary rehabilitation; without continuous oximetry monitoring (per session) ","code_information":[{"code":"94625","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Pollicization of a digit ","code_information":[{"code":"26550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Primary closure sinus perf ","code_information":[{"code":"D7261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2287.60,"maximum":2383.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2287.60,"methodology":"fee schedule"}]}]},{"description":"Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage; cryotherapy, diathermy ","code_information":[{"code":"67141","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":431.30,"maximum":449.46,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":449.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":449.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":431.30,"methodology":"fee schedule"}]}]},{"description":"Radiation shield ","code_information":[{"code":"D5984","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2287.60,"maximum":2383.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2287.60,"methodology":"fee schedule"}]}]},{"description":"Radical resection of tumor; phalanx of toe ","code_information":[{"code":"28175","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination, mastoids; complete, minimum of 3 views per side ","code_information":[{"code":"70130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133.00,"maximum":138.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":133.00,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination; calcaneus, minimum of 2 views ","code_information":[{"code":"73650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133.00,"maximum":138.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":133.00,"methodology":"fee schedule"}]}]},{"description":"Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) ","code_information":[{"code":"23420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Reconstruction, collateral ligament, metacarpophalangeal joint, single; with tendon or fascial graft (includes obtaining graft) ","code_information":[{"code":"26541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed; ","code_information":[{"code":"95990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":165.30,"maximum":172.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":172.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":172.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":165.30,"methodology":"fee schedule"}]}]},{"description":"Removal of foreign body in muscle or tendon sheath; deep or complicated ","code_information":[{"code":"20525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Removal, entire osseointegrated implant, skull; with percutaneous attachment to external speech processor ","code_information":[{"code":"69726","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Repair of laceration 2.5 cm or less; floor of mouth and/or anterior two-thirds of tongue ","code_information":[{"code":"41250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":447.45,"maximum":466.29,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":466.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":466.29,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":447.45,"methodology":"fee schedule"}]}]},{"description":"REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; REDUCIBLE ","code_information":[{"code":"49565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8345.75,"maximum":8697.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8345.75,"methodology":"fee schedule"}]}]},{"description":"Repair, congenital arteriovenous fistula; extremities ","code_information":[{"code":"35184","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4721.50,"maximum":4920.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4721.50,"methodology":"fee schedule"}]}]},{"description":"Replacement or irrigation, subarachnoid/subdural catheter ","code_information":[{"code":"62194","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2895.60,"maximum":3017.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2895.60,"methodology":"fee schedule"}]}]},{"description":"Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical ","code_information":[{"code":"22861","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26668.40,"maximum":27791.28,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26668.40,"methodology":"fee schedule"}]}]},{"description":"Revision, femoral anastomosis of synthetic arterial bypass graft in groin, open; with nonautogenous patch graft (eg, polyester, ePTFE, bovine pericardium) ","code_information":[{"code":"35883","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7865.05,"maximum":8196.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7865.05,"methodology":"fee schedule"}]}]},{"description":"Sensorimotor examination with multiple measurements of ocular deviation (eg, restrictive or paretic muscle with diplopia) with interpretation and report (separate procedure) ","code_information":[{"code":"92060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with transendoscopic stent placement (includes predilation) ","code_information":[{"code":"44379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8302.05,"maximum":8651.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8651.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8651.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8302.05,"methodology":"fee schedule"}]}]},{"description":"Spinal puncture, lumbar, diagnostic; ","code_information":[{"code":"62270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1046.90,"maximum":1090.98,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1090.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1090.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1046.90,"methodology":"fee schedule"}]}]},{"description":"Strapping; thorax ","code_information":[{"code":"29200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":232.75,"maximum":242.55,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":242.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":242.55,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":232.75,"methodology":"fee schedule"}]}]},{"description":"Suture of quadriceps or hamstring muscle rupture; secondary reconstruction, including fascial or tendon graft ","code_information":[{"code":"27386","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Tenotomy, percutaneous, single, each digit ","code_information":[{"code":"26060","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Thoracoscopy; with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral ","code_information":[{"code":"32607","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8345.75,"maximum":8697.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8345.75,"methodology":"fee schedule"}]}]},{"description":"Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervision and interpretation, initial treatment day ","code_information":[{"code":"37212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4721.50,"maximum":4920.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4721.50,"methodology":"fee schedule"}]}]},{"description":"Transplant preparation of hematopoietic progenitor cells; red blood cell removal ","code_information":[{"code":"38212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":654.55,"maximum":682.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":682.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":682.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":654.55,"methodology":"fee schedule"}]}]},{"description":"Ultrasound, pregnant uterus, real time with image documentation, transvaginal ","code_information":[{"code":"76817","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Unlisted procedure, endocrine system ","code_information":[{"code":"60699","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8345.75,"maximum":8697.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8345.75,"methodology":"fee schedule"}]}]},{"description":"Unlisted reproductive medicine laboratory procedure ","code_information":[{"code":"89398","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":245.10,"maximum":255.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":245.10,"methodology":"fee schedule"}]}]},{"description":"Ustekinumab, for intravenous injection, 1 mg ","code_information":[{"code":"J3358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":27.55,"maximum":28.71,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":28.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":28.71,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":27.55,"methodology":"fee schedule"}]}]},{"description":"Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (eg, Goldmann visual fields with at least 3 isopters plotted and static determination within the ","code_information":[{"code":"92083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91.20,"maximum":95.04,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":91.20,"methodology":"fee schedule"}]}]},{"description":"Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motionºs» and/or ejection fractionºs», when performed); single study, at rest or stress (exercise or ","code_information":[{"code":"78491","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":621.30,"maximum":647.46,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":621.30,"methodology":"fee schedule"}]}]},{"description":"Needle electromyography; limited study of muscles in 1 extremity or non-limb (axial) muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters ","code_information":[{"code":"95870","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229.90,"maximum":239.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":239.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":239.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":229.90,"methodology":"fee schedule"}]}]},{"description":"Nerve repair; with synthetic conduit or vein allograft (eg, nerve tube), each nerve ","code_information":[{"code":"64910","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9405.00,"maximum":9801.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9405.00,"methodology":"fee schedule"}]}]},{"description":"Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; without repair or internal fixation ","code_information":[{"code":"27846","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each bone ","code_information":[{"code":"26615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits ","code_information":[{"code":"92004","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Ostectomy, complete excision; all metatarsal heads, with partial proximal phalangectomy, excluding first metatarsal (eg, Clayton type procedure) ","code_information":[{"code":"28114","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Osteotomy; metacarpal, each ","code_information":[{"code":"26565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; thoracic ","code_information":[{"code":"22112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch ","code_information":[{"code":"92924","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":436.05,"maximum":454.41,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":436.05,"methodology":"fee schedule"}]}]},{"description":"Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological s ","code_information":[{"code":"50695","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent ","code_information":[{"code":"68815","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"PROGRAMMING DEVICE EVALUATION OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM FOR CENTRAL SLEEP APNEA; SINGLE SESSION ","code_information":[{"code":"0435T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":165.30,"maximum":172.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":172.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":172.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":165.30,"methodology":"fee schedule"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of back or flank; less than 5 cm ","code_information":[{"code":"21935","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation ","code_information":[{"code":"76080","type":"CPT"},{"code":"905182","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":7865.05,"maximum":8196.21,"gross_charge":1566.96,"discounted_cash":1566.96,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7865.05,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination, teeth; single view ","code_information":[{"code":"70300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133.00,"maximum":138.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":133.00,"methodology":"fee schedule"}]}]},{"description":"Reconstruction midface, LeFort II; any direction, requiring bone grafts (includes obtaining autografts) ","code_information":[{"code":"21151","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Reconstruction, toe(s); polydactyly ","code_information":[{"code":"28344","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Removal of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator ","code_information":[{"code":"64570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9405.00,"maximum":9801.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9405.00,"methodology":"fee schedule"}]}]},{"description":"Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion ","code_information":[{"code":"36590","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2318.95,"maximum":2416.59,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2416.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2416.59,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2318.95,"methodology":"fee schedule"}]}]},{"description":"Repair of blepharoptosis; (tarso) levator resection or advancement, external approach ","code_information":[{"code":"67904","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Repair, intrinsic muscles of hand, each muscle ","code_information":[{"code":"26591","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Respiratory flow volume loop ","code_information":[{"code":"94375","type":"CPT"},{"code":"946743","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":436.05,"maximum":454.41,"gross_charge":2402.48,"discounted_cash":2402.48,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":436.05,"methodology":"fee schedule"}]}]},{"description":"Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component ","code_information":[{"code":"23474","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14000.00,"maximum":21193.92,"payers_information":[{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14000.00,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to surgical neck ","code_information":[{"code":"23174","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Sinusotomy frontal; nonobliterative, with osteoplastic flap, coronal incision ","code_information":[{"code":"31087","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording ","code_information":[{"code":"92541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc ","code_information":[{"code":"11951","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":863.55,"maximum":899.91,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":863.55,"methodology":"fee schedule"}]}]},{"description":"Synovectomy, proximal interphalangeal joint, including extensor reconstruction, each interphalangeal joint ","code_information":[{"code":"26140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Tenolysis, extensor, foot; multiple tendons ","code_information":[{"code":"28226","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Thrombectomy, direct or with catheter; axillary and subclavian vein, by arm incision ","code_information":[{"code":"34490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4721.50,"maximum":4920.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4721.50,"methodology":"fee schedule"}]}]},{"description":"Transection or avulsion of obturator nerve, extrapelvic, with or without adductor tenotomy ","code_information":[{"code":"64763","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2895.60,"maximum":3017.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2895.60,"methodology":"fee schedule"}]}]},{"description":"Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy ","code_information":[{"code":"55875","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7277.00,"maximum":7583.40,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7277.00,"methodology":"fee schedule"}]}]},{"description":"Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction ","code_information":[{"code":"69636","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Unlisted fluoroscopic procedure (eg, diagnostic, interventional) ","code_information":[{"code":"76496","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":557.65,"maximum":581.13,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":581.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":581.13,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":557.65,"methodology":"fee schedule"}]}]},{"description":"Unlisted procedure, esophagus ","code_information":[{"code":"43499","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1333.80,"maximum":1389.96,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1333.80,"methodology":"fee schedule"}]}]},{"description":"Urethrolysis, transvaginal, secondary, open, including cystourethroscopy (eg, postsurgical obstruction, scarring) ","code_information":[{"code":"53500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both submandibular (Wharton's) ducts ","code_information":[{"code":"42510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4 ","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1435.50,"maximum":1435.50,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"}]}]},{"description":"Percutaneous skeletal fixation of ulnar styloid fracture ","code_information":[{"code":"25651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple ","code_information":[{"code":"55876","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2082.40,"maximum":2170.08,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2170.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2170.08,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2082.40,"methodology":"fee schedule"}]}]},{"description":"Plastic operation on urethral sphincter, vaginal approach (eg, Kelly urethral plication) ","code_information":[{"code":"57220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7272.25,"maximum":7578.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7578.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7578.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7272.25,"methodology":"fee schedule"}]}]},{"description":"Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; incubation with chemical agents or drugs, each ","code_information":[{"code":"86970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55.10,"maximum":57.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":55.10,"methodology":"fee schedule"}]}]},{"description":"Prostatotomy, external drainage of prostatic abscess, any approach; simple ","code_information":[{"code":"55720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of face or scalp; less than 2 cm ","code_information":[{"code":"21015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination, hand; 2 views ","code_information":[{"code":"73120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179.55,"maximum":187.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination, spine; thoracic, minimum of 4 views ","code_information":[{"code":"72074","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179.55,"maximum":187.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"Reconstruction external auditory canal for congenital atresia, single stage ","code_information":[{"code":"69320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":295.45,"maximum":307.89,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":295.45,"methodology":"fee schedule"}]}]},{"description":"Red blood cells, each unit ","code_information":[{"code":"P9021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":310.65,"maximum":323.73,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":323.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":323.73,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":310.65,"methodology":"fee schedule"}]}]},{"description":"Removal of corneal epithelium; with application of chelating agent (eg, EDTA) ","code_information":[{"code":"65436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Removal of prosthesis, includes debridement and synovectomy when performed; radial head ","code_information":[{"code":"24164","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Removal of all components of a multi-component, inflatable penile prosthesis without replacement of prosthesis ","code_information":[{"code":"54406","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Removal of foreign body, external eye; corneal, with slit lamp ","code_information":[{"code":"65222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Removal of peritoneal foreign body from peritoneal cavity ","code_information":[{"code":"49402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5246.85,"maximum":5467.77,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5246.85,"methodology":"fee schedule"}]}]},{"description":"Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical ","code_information":[{"code":"22864","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20337.60,"maximum":21193.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Repair blood vessel, direct; upper extremity ","code_information":[{"code":"35206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4721.50,"maximum":4920.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4721.50,"methodology":"fee schedule"}]}]},{"description":"Repair of laceration; conjunctiva, with or without nonperforating laceration sclera, direct closure ","code_information":[{"code":"65270","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Repair, extensor tendon, finger, primary or secondary; with free graft (includes obtaining graft) each tendon ","code_information":[{"code":"26420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Repair, primary, torn ligament and/or capsule, knee; collateral ","code_information":[{"code":"27405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy, includes angioplasty within the same vessel, when ","code_information":[{"code":"37227","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26488.85,"maximum":27604.17,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27604.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27604.17,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26488.85,"methodology":"fee schedule"}]}]},{"description":"Rhytidectomy; forehead ","code_information":[{"code":"15824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2824.35,"maximum":2943.27,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2824.35,"methodology":"fee schedule"}]}]},{"description":"Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration ","code_information":[{"code":"99473","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60.80,"maximum":63.36,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":60.80,"methodology":"fee schedule"}]}]},{"description":"Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral ","code_information":[{"code":"42330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"Sinusotomy frontal; obliterative, with osteoplastic flap, brow incision ","code_information":[{"code":"31084","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Sperm isolation; complex prep (eg, Percoll gradient, albumin gradient) for insemination or diagnosis with semen analysis ","code_information":[{"code":"89261","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81.70,"maximum":85.14,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":85.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":85.14,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":81.70,"methodology":"fee schedule"}]}]},{"description":"Suture of 1 nerve; hand or foot, common sensory nerve ","code_information":[{"code":"64834","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9405.00,"maximum":9801.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9405.00,"methodology":"fee schedule"}]}]},{"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"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Thoracoscopy, diagnostic (separate procedure); lungs, pericardial sac, mediastinal or pleural space, without biopsy ","code_information":[{"code":"32601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8345.75,"maximum":8697.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8345.75,"methodology":"fee schedule"}]}]},{"description":"Transcatheter removal of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography), when performed ","code_information":[{"code":"33275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4721.50,"maximum":4920.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4721.50,"methodology":"fee schedule"}]}]},{"description":"Transfusion, intrauterine, fetal ","code_information":[{"code":"36460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":654.55,"maximum":682.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":682.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":682.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":654.55,"methodology":"fee schedule"}]}]},{"description":"Treatment of complications ","code_information":[{"code":"D9930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2287.60,"maximum":2383.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2287.60,"methodology":"fee schedule"}]}]},{"description":"Ultrasound, elastography; parenchyma (eg, organ) ","code_information":[{"code":"76981","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":436.05,"maximum":454.41,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":436.05,"methodology":"fee schedule"}]}]},{"description":"Unlisted procedure, arthroscopy ","code_information":[{"code":"29999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Urography (pyelography), intravenous, with or without KUB, with or without tomography ","code_information":[{"code":"74400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":294.50,"maximum":306.90,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":306.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":306.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":294.50,"methodology":"fee schedule"}]}]},{"description":"Whole blood, leukocytes reduced, irradiated, each unit ","code_information":[{"code":"P9056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1327.15,"maximum":1383.03,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1383.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1383.03,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1327.15,"methodology":"fee schedule"}]}]},{"description":"Ablation, renal tumor(s), unilateral, percutaneous, cryotherapy ","code_information":[{"code":"50593","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14689.85,"maximum":15308.37,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":14689.85,"methodology":"fee schedule"}]}]},{"description":"Amputation, thigh, through femur, any level; open, circular (guillotine) ","code_information":[{"code":"27592","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26668.40,"maximum":27791.28,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26668.40,"methodology":"fee schedule"}]}]},{"description":"Appendectomy; ","code_information":[{"code":"44950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5246.85,"maximum":5467.77,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5246.85,"methodology":"fee schedule"}]}]},{"description":"Application of on-body injector (includes cannula insertion) for timed subcutaneous injection ","code_information":[{"code":"96377","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101.65,"maximum":105.93,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":105.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":105.93,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":101.65,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, knee, any technique ","code_information":[{"code":"27580","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20337.60,"maximum":21193.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction ","code_information":[{"code":"29888","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy, acromioclavicular, sternoclavicular joint, including exploration, drainage, or removal of foreign body ","code_information":[{"code":"23044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy, wrist joint; with joint exploration, with or without biopsy, with or without removal of loose or foreign body ","code_information":[{"code":"25101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Biopsy of intestine by capsule, tube, peroral (1 or more specimens) ","code_information":[{"code":"44100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1333.80,"maximum":1389.96,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1333.80,"methodology":"fee schedule"}]}]},{"description":"Bladder irrigation, simple, lavage and/or instillation ","code_information":[{"code":"51700","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":438.90,"maximum":457.38,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":457.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":457.38,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":438.90,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe ","code_information":[{"code":"31660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9604.50,"maximum":10008.90,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10008.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10008.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9604.50,"methodology":"fee schedule"}]}]},{"description":"Canthoplasty (reconstruction of canthus) ","code_information":[{"code":"67950","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) i ","code_information":[{"code":"93455","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4782.30,"maximum":4983.66,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4983.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4983.66,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4782.30,"methodology":"fee schedule"}]}]},{"description":"Cholinesterase inhibitor challenge test for myasthenia gravis ","code_information":[{"code":"95857","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":436.05,"maximum":454.41,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":436.05,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of fracture great toe, phalanx or phalanges; without manipulation ","code_information":[{"code":"28490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each ","code_information":[{"code":"26725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy through stoma; with endoscopic stent placement (including pre- and post-dilation and guide wire passage, when performed) ","code_information":[{"code":"44402","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8302.05,"maximum":8651.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8651.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8651.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8302.05,"methodology":"fee schedule"}]}]},{"description":"Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed ","code_information":[{"code":"93453","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":796.10,"maximum":829.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":829.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":829.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":796.10,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lower extremity; with contrast material(s) ","code_information":[{"code":"73701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133.00,"maximum":138.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":133.00,"methodology":"fee schedule"}]}]},{"description":"Conjunctival flap; total (such as Gunderson thin flap or purse string flap) ","code_information":[{"code":"68362","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5453.00,"maximum":5682.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5682.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5682.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5453.00,"methodology":"fee schedule"}]}]},{"description":"Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with distal metatarsal osteotomy, any method ","code_information":[{"code":"28296","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Cystotomy or cystostomy; with cryosurgical destruction of intravesical lesion ","code_information":[{"code":"51030","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site ","code_information":[{"code":"88172","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":43.70,"maximum":45.54,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":45.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":45.54,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":43.70,"methodology":"fee schedule"}]}]},{"description":"Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus ","code_information":[{"code":"64680","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1357.55,"maximum":1414.71,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1414.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1414.71,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1357.55,"methodology":"fee schedule"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm ","code_information":[{"code":"17263","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":295.45,"maximum":307.89,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":295.45,"methodology":"fee schedule"}]}]},{"description":"Drainage external ear, abscess or hematoma; complicated ","code_information":[{"code":"69005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":431.30,"maximum":449.46,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":449.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":449.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":431.30,"methodology":"fee schedule"}]}]},{"description":"Electroencephalogram (EEG); cerebral death evaluation only ","code_information":[{"code":"95824","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":436.05,"maximum":454.41,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":454.41,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":436.05,"methodology":"fee schedule"}]}]},{"description":"Endoscopic submucosal dissection (esd), including endoscopy or colonoscopy, mucosal closure, when performed ","code_information":[{"code":"C9779","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26488.85,"maximum":27604.17,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27604.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27604.17,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26488.85,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance ","code_information":[{"code":"43201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2678.05,"maximum":2790.81,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2790.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2790.81,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2678.05,"methodology":"fee schedule"}]}]},{"description":"Excision first and/or cervical rib; ","code_information":[{"code":"21615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Imaging of retina for detection or monitoring of disease; with remote clinical staff review and report, unilateral or bilateral ","code_information":[{"code":"92227","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Impression and custom preparation; surgical obturator prosthesis ","code_information":[{"code":"21076","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2230.60,"maximum":2324.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2230.60,"methodology":"fee schedule"}]}]},{"description":"Incision and drainage, bursa, foot ","code_information":[{"code":"28001","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2319.90,"maximum":2417.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2319.90,"methodology":"fee schedule"}]}]},{"description":"Injection of sclerosing solution, hemorrhoids ","code_information":[{"code":"46500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1308.15,"maximum":1363.23,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1308.15,"methodology":"fee schedule"}]}]},{"description":"Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solut ","code_information":[{"code":"62327","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1357.55,"maximum":1414.71,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1414.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1414.71,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1357.55,"methodology":"fee schedule"}]}]},{"description":"Injection, c-1 esterase inhibitor (human), cinryze, 10 units ","code_information":[{"code":"J0598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7.60,"maximum":7.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7.60,"methodology":"fee schedule"}]}]},{"description":"Injection, dostarlimab-gxly, 10 mg ","code_information":[{"code":"J9272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3335.45,"maximum":3475.89,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3475.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3475.89,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3335.45,"methodology":"fee schedule"}]}]},{"description":"Injection, fosnetupitant 235 mg and palonosetron 0.25 mg ","code_information":[{"code":"J1454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":0.95,"maximum":0.99,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":0.95,"methodology":"fee schedule"}]}]},{"description":"Injection, naxitamab-gqgk, 1 mg ","code_information":[{"code":"J9348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":92.15,"maximum":96.03,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":92.15,"methodology":"fee schedule"}]}]},{"description":"Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg ","code_information":[{"code":"Q5119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":86.45,"maximum":90.09,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":90.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":90.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":86.45,"methodology":"fee schedule"}]}]},{"description":"Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel selection, and radiological supervision and interpretation, intraprocedural roadmapping, and imagin ","code_information":[{"code":"37191","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7865.05,"maximum":8196.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7865.05,"methodology":"fee schedule"}]}]},{"description":"Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older ","code_information":[{"code":"36561","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4721.50,"maximum":4920.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4721.50,"methodology":"fee schedule"}]}]},{"description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient en ","code_information":[{"code":"93292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60.80,"maximum":63.36,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":60.80,"methodology":"fee schedule"}]}]},{"description":"Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); 3 or more segments ","code_information":[{"code":"22819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26668.40,"maximum":27791.28,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26668.40,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling, peritoneal washings, peritoneal biopsy(ies), omentectomy, and diaphragmatic washings, including ","code_information":[{"code":"38573","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14689.85,"maximum":15308.37,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":14689.85,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope ","code_information":[{"code":"31541","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5109.10,"maximum":5324.22,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5324.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5324.22,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5109.10,"methodology":"fee schedule"}]}]},{"description":"Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral ","code_information":[{"code":"58600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4327.25,"maximum":4509.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4327.25,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography with contrast, lower extremity ","code_information":[{"code":"C8912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":607.05,"maximum":632.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":607.05,"methodology":"fee schedule"}]}]},{"description":"Mastoid obliteration (separate procedure) ","code_information":[{"code":"69670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Multiple osteotomies with realignment on intramedullary rod, humeral shaft (Sofield type procedure) ","code_information":[{"code":"24410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20337.60,"maximum":21193.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus ","code_information":[{"code":"31259","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9604.50,"maximum":10008.90,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10008.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10008.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9604.50,"methodology":"fee schedule"}]}]},{"description":"Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; up to 4 cm length ","code_information":[{"code":"64895","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9405.00,"maximum":9801.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9405.00,"methodology":"fee schedule"}]}]},{"description":"Occupational therapy evaluation, high complexity, requiring these components: An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and exten ","code_information":[{"code":"892568","type":"CDM"},{"code":"97167","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":135.85,"maximum":141.57,"gross_charge":1789.16,"discounted_cash":1789.16,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":141.57,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":141.57,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":135.85,"methodology":"fee schedule"}]}]},{"description":"Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement ","code_information":[{"code":"27236","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Open treatment of metacarpophalangeal dislocation, single, includes internal fixation, when performed ","code_information":[{"code":"26715","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed; with radial head prosthetic replacement ","code_information":[{"code":"24666","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20337.60,"maximum":21193.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with recording ","code_information":[{"code":"92544","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229.90,"maximum":239.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":239.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":239.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":229.90,"methodology":"fee schedule"}]}]},{"description":"Osteotomy, iliac, acetabular or innominate bone; ","code_information":[{"code":"27146","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Parotid duct diversion, bilateral (Wilke type procedure); with excision of both submandibular glands ","code_information":[{"code":"42509","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), initial site ","code_information":[{"code":"88333","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81.70,"maximum":85.14,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":85.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":85.14,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":81.70,"methodology":"fee schedule"}]}]},{"description":"Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulation ","code_information":[{"code":"21355","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance ","code_information":[{"code":"19283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1026.00,"maximum":1069.20,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1026.00,"methodology":"fee schedule"}]}]},{"description":"Platelets, hla-matched leukocytes reduced, apheresis/pheresis, each unit ","code_information":[{"code":"P9052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":33.25,"maximum":34.65,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":33.25,"methodology":"fee schedule"}]}]},{"description":"Proctosigmoidoscopy, rigid; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) ","code_information":[{"code":"45317","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1710.00,"maximum":1782.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1782.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1782.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1710.00,"methodology":"fee schedule"}]}]},{"description":"Quadricepsplasty (eg, Bennett or Thompson type) ","code_information":[{"code":"27430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax; less than 5 cm ","code_information":[{"code":"21557","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination, elbow; 2 views ","code_information":[{"code":"73070","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133.00,"maximum":138.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":133.00,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination, sacroiliac joints; 3 or more views ","code_information":[{"code":"72202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Radiopharmaceutical therapy, by oral administration ","code_information":[{"code":"79005","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2154.60,"maximum":2245.32,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2245.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2245.32,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2154.60,"methodology":"fee schedule"}]}]},{"description":"Reduction forehead; contouring and setback of anterior frontal sinus wall ","code_information":[{"code":"21139","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Removal of indwelling tunneled pleural catheter with cuff ","code_information":[{"code":"32552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":891.10,"maximum":928.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":928.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":928.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":891.10,"methodology":"fee schedule"}]}]},{"description":"Removal of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed ","code_information":[{"code":"63662","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5402.65,"maximum":5630.13,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5630.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5630.13,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5402.65,"methodology":"fee schedule"}]}]},{"description":"Removal of wrist prosthesis; complicated, including total wrist ","code_information":[{"code":"25251","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Repair blood vessel, direct; neck ","code_information":[{"code":"35201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7865.05,"maximum":8196.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7865.05,"methodology":"fee schedule"}]}]},{"description":"Repair of hypospadias complication(s) (ie, fistula, stricture, diverticula); by closure, incision, or excision, simple ","code_information":[{"code":"54340","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Repair of retinal detachment; by injection of air or other gas (eg, pneumatic retinopexy) ","code_information":[{"code":"67110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3424.75,"maximum":3568.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3424.75,"methodology":"fee schedule"}]}]},{"description":"Repair, flexor tendon, leg; secondary, with or without graft, each tendon ","code_information":[{"code":"27659","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report ","code_information":[{"code":"49450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1333.80,"maximum":1389.96,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1333.80,"methodology":"fee schedule"}]}]},{"description":"Resection, partial or complete, phalangeal base, each toe ","code_information":[{"code":"28126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array ","code_information":[{"code":"63688","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5402.65,"maximum":5630.13,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5630.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5630.13,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5402.65,"methodology":"fee schedule"}]}]},{"description":"Septal or other intranasal dermatoplasty (does not include obtaining graft) ","code_information":[{"code":"30620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion ","code_information":[{"code":"Q2043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":415.15,"maximum":432.63,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":432.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":432.63,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":415.15,"methodology":"fee schedule"}]}]},{"description":"Speech audiometry threshold, automated; with speech recognition ","code_information":[{"code":"0211T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55.10,"maximum":57.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":55.10,"methodology":"fee schedule"}]}]},{"description":"Surgical treatment of anal fistula (fistulectomy/fistulotomy); transsphincteric, suprasphincteric, extrasphincteric or multiple, including placement of seton, when performed ","code_information":[{"code":"46280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4028.95,"maximum":4198.59,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4028.95,"methodology":"fee schedule"}]}]},{"description":"Tenolysis, triceps ","code_information":[{"code":"24332","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral ","code_information":[{"code":"64628","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20337.60,"maximum":21193.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Trabeculotomy ab externo ","code_information":[{"code":"65850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3424.75,"maximum":3568.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3424.75,"methodology":"fee schedule"}]}]},{"description":"Transection or avulsion of other spinal nerve, extradural ","code_information":[{"code":"64772","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2895.60,"maximum":3017.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2895.60,"methodology":"fee schedule"}]}]},{"description":"Treatment of closed elbow dislocation; requiring anesthesia ","code_information":[{"code":"24605","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Unlisted craniofacial and maxillofacial procedure ","code_information":[{"code":"21299","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":348.65,"maximum":363.33,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":363.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":363.33,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":348.65,"methodology":"fee schedule"}]}]},{"description":"Unlisted nervous system procedure, diagnostic nuclear medicine ","code_information":[{"code":"78699","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":806.55,"maximum":840.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":840.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":840.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":806.55,"methodology":"fee schedule"}]}]},{"description":"Unlisted procedure, vascular surgery ","code_information":[{"code":"37799","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":891.10,"maximum":928.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":928.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":928.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":891.10,"methodology":"fee schedule"}]}]},{"description":"Vasotomy, cannulization with or without incision of vas, unilateral or bilateral (separate procedure) ","code_information":[{"code":"55200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Ablation, percutaneous, cryoablation, includes imaging guidance; nerve plexus or other truncal nerve (eg, brachial plexus, pudendal nerve) ","code_information":[{"code":"0442T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9405.00,"maximum":9801.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9405.00,"methodology":"fee schedule"}]}]},{"description":"Adding walker to previously applied cast ","code_information":[{"code":"29440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":232.75,"maximum":242.55,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":242.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":242.55,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":232.75,"methodology":"fee schedule"}]}]},{"description":"Amputation, arm through humerus; with primary closure ","code_information":[{"code":"24900","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20337.60,"maximum":21193.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Antibody elution (RBC), each elution ","code_information":[{"code":"86860","type":"CPT"},{"code":"902405","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":893.95,"maximum":931.59,"gross_charge":650.27,"discounted_cash":650.27,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":931.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":931.59,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":893.95,"methodology":"fee schedule"}]}]},{"description":"Application, cast; plaster Velpeau ","code_information":[{"code":"29058","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":397.10,"maximum":413.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":413.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":413.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":397.10,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, elbow joint; with autogenous graft (includes obtaining graft) ","code_information":[{"code":"24802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20337.60,"maximum":21193.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, wrist; limited, without bone graft (eg, intercarpal or radiocarpal) ","code_information":[{"code":"25820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy, including exploration, drainage, or removal of loose or foreign body; intertarsal or tarsometatarsal joint ","code_information":[{"code":"28020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Bioimpedance spectroscopy (BIS), extracellular fluid analysis for lymphedema assessment(s) ","code_information":[{"code":"93702","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35393.20,"maximum":36883.44,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":36883.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":36883.44,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":35393.20,"methodology":"fee schedule"}]}]},{"description":"Biopsy, pleura, percutaneous needle ","code_information":[{"code":"32400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2319.90,"maximum":2417.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2319.90,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage ","code_information":[{"code":"31624","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2467.15,"maximum":2571.03,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2571.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2571.03,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2467.15,"methodology":"fee schedule"}]}]},{"description":"Cartilage graft; nasal septum ","code_information":[{"code":"20912","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5807.35,"maximum":6051.87,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":6051.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":6051.87,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5807.35,"methodology":"fee schedule"}]}]},{"description":"Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump ","code_information":[{"code":"96425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101.65,"maximum":105.93,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":105.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":105.93,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":101.65,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of clavicular fracture; without manipulation ","code_information":[{"code":"23500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure) ","code_information":[{"code":"21440","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid processºes»); without manipulation ","code_information":[{"code":"24670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibia ","code_information":[{"code":"905754","type":"CDM"},{"code":"93923","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"gross_charge":919.05,"discounted_cash":919.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, upper extremity; with contrast material(s) ","code_information":[{"code":"73201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179.55,"maximum":187.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"Correction of lid retraction ","code_information":[{"code":"67911","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with insertion of transprostatic implant; 1 to 3 implants ","code_information":[{"code":"C9739","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2230.60,"maximum":2324.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2230.60,"methodology":"fee schedule"}]}]},{"description":"Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less ","code_information":[{"code":"11044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2319.90,"maximum":2417.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2319.90,"methodology":"fee schedule"}]}]},{"description":"Destruction by neurolytic agent; pudendal nerve ","code_information":[{"code":"64630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1357.55,"maximum":1414.71,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1414.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1414.71,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1357.55,"methodology":"fee schedule"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm ","code_information":[{"code":"17262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":295.45,"maximum":307.89,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":295.45,"methodology":"fee schedule"}]}]},{"description":"Displacement therapy (Proetz type) ","code_information":[{"code":"30210","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2230.60,"maximum":2324.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2230.60,"methodology":"fee schedule"}]}]},{"description":"Duodenal intubation and aspiration, diagnostic, includes image guidance; single specimen (eg, bile study for crystals or afferent loop culture) ","code_information":[{"code":"43756","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1333.80,"maximum":1389.96,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1333.80,"methodology":"fee schedule"}]}]},{"description":"Electroencephalogram (EEG) extended monitoring; 61-119 minutes ","code_information":[{"code":"95813","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1517.15,"maximum":1581.03,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1581.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1581.03,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1517.15,"methodology":"fee schedule"}]}]},{"description":"Electrophysiologic evaluation of implantable cardioverter-defibrillator system with substernal electrode (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing f ","code_information":[{"code":"0577T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1836.35,"maximum":1913.67,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1913.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1913.67,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1836.35,"methodology":"fee schedule"}]}]},{"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":"91038","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":804.65,"maximum":838.53,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":838.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":838.53,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":804.65,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) ","code_information":[{"code":"43200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1333.80,"maximum":1389.96,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1333.80,"methodology":"fee schedule"}]}]},{"description":"Excision inferior turbinate, partial or complete, any method ","code_information":[{"code":"30130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"Excision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) ","code_information":[{"code":"40525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"Excision of thrombosed hemorrhoid, external ","code_information":[{"code":"46320","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1710.00,"maximum":1782.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1782.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1782.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1710.00,"methodology":"fee schedule"}]}]},{"description":"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm ","code_information":[{"code":"11602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":570.00,"maximum":594.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":570.00,"methodology":"fee schedule"}]}]},{"description":"Excision, tumor, soft tissue of leg or ankle area, subfascial (eg, intramuscular); less than 5 cm ","code_information":[{"code":"27619","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Factor viii (antihemophilic factor, human) per i.u. ","code_information":[{"code":"J7190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":0.95,"maximum":0.99,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":0.99,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":0.95,"methodology":"fee schedule"}]}]},{"description":"Flap; neurovascular pedicle ","code_information":[{"code":"15750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5807.35,"maximum":6051.87,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":6051.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":6051.87,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5807.35,"methodology":"fee schedule"}]}]},{"description":"Full mouth debridement ","code_information":[{"code":"D4355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2287.60,"maximum":2383.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2287.60,"methodology":"fee schedule"}]}]},{"description":"Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate ","code_information":[{"code":"15773","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2824.35,"maximum":2943.27,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2824.35,"methodology":"fee schedule"}]}]},{"description":"Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose ","code_information":[{"code":"J7324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28.50,"maximum":29.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":29.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":29.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":28.50,"methodology":"fee schedule"}]}]},{"description":"Implantation or replacement of carotid sinus baroreflex activation device; total system (includes generator placement, unilateral or bilateral lead placement, intra-operative interrogation, programmin ","code_information":[{"code":"0266T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48551.65,"maximum":50595.93,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":50595.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":50595.93,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":48551.65,"methodology":"fee schedule"}]}]},{"description":"Infusion or instillation of radioelement solution (includes 3-month follow-up care) ","code_information":[{"code":"77750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1169.45,"maximum":1218.69,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1218.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1218.69,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1169.45,"methodology":"fee schedule"}]}]},{"description":"Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and inte ","code_information":[{"code":"47531","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5246.85,"maximum":5467.77,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5246.85,"methodology":"fee schedule"}]}]},{"description":"Injection, amivantamab-vmjw, 2 mg ","code_information":[{"code":"J9061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":66.50,"maximum":69.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":69.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":69.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":66.50,"methodology":"fee schedule"}]}]},{"description":"Injection, caplacizumab-yhdp, 1 mg ","code_information":[{"code":"C9047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Injection, etanercept, 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) ","drug_information":{"unit":"25","type":"ME"},"code_information":[{"code":"906545","type":"CDM"},{"code":"J1438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":95.00,"maximum":99.00,"gross_charge":1834.48,"discounted_cash":1834.48,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":99.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":99.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":95.00,"methodology":"fee schedule"}]}]},{"description":"Injection, human fibrinogen concentrate, not otherwise specified, 1 mg ","code_information":[{"code":"J7178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2.85,"maximum":2.97,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2.97,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2.85,"methodology":"fee schedule"}]}]},{"description":"Injection, melphalan hydrochloride, not otherwise specified, 50 mg ","code_information":[{"code":"J9245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":111.15,"maximum":115.83,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":115.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":115.83,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":111.15,"methodology":"fee schedule"}]}]},{"description":"Injection, posterior chamber of eye, medication ","code_information":[{"code":"0699T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3424.75,"maximum":3568.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3424.75,"methodology":"fee schedule"}]}]},{"description":"Injection, teniposide, 50 mg ","code_information":[{"code":"Q2017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26.60,"maximum":27.72,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26.60,"methodology":"fee schedule"}]}]},{"description":"Insertion of ocular telescope prosthesis including removal of crystalline lens or intraocular lens prosthesis ","code_information":[{"code":"0308T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39027.90,"maximum":40671.18,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":40671.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":40671.18,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":39027.90,"methodology":"fee schedule"}]}]},{"description":"Insertion or replacement of cranial neurostimulator pulse generator or receiver, direct or inductive coupling; with connection to a single electrode array ","code_information":[{"code":"61885","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":33773.45,"maximum":35195.49,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":35195.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":35195.49,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":33773.45,"methodology":"fee schedule"}]}]},{"description":"Interrogation of ventricular assist device (VAD), in person, with physician or other qualified health care professional analysis of device parameters (eg, drivelines, alarms, power surges), review of ","code_information":[{"code":"93750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229.90,"maximum":239.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":239.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":239.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":229.90,"methodology":"fee schedule"}]}]},{"description":"Iridectomy, with corneoscleral or corneal section; optical (separate procedure) ","code_information":[{"code":"66635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3424.75,"maximum":3568.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3424.75,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) ","code_information":[{"code":"58573","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14689.85,"maximum":15308.37,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":14689.85,"methodology":"fee schedule"}]}]},{"description":"Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed ","code_information":[{"code":"93452","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":796.10,"maximum":829.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":829.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":829.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":796.10,"methodology":"fee schedule"}]}]},{"description":"Ligation, major artery (eg, post-traumatic, rupture); abdomen ","code_information":[{"code":"37617","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4721.50,"maximum":4920.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4721.50,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material ","code_information":[{"code":"73721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":294.50,"maximum":306.90,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":306.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":306.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":294.50,"methodology":"fee schedule"}]}]},{"description":"Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring an anesthesia service (ie, general or monitored anesthesia care) ","code_information":[{"code":"21073","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2230.60,"maximum":2324.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2230.60,"methodology":"fee schedule"}]}]},{"description":"Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hou ","code_information":[{"code":"G0271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":195.70,"maximum":203.94,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":203.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":203.94,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":195.70,"methodology":"fee schedule"}]}]},{"description":"Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motionºs» and/or ejection fractionºs», when performed), dual radi ","code_information":[{"code":"78432","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":621.30,"maximum":647.46,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":621.30,"methodology":"fee schedule"}]}]},{"description":"Nasopharyngoscopy with endoscope (separate procedure) ","code_information":[{"code":"92511","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91.20,"maximum":95.04,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":91.20,"methodology":"fee schedule"}]}]},{"description":"Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array ","code_information":[{"code":"64582","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":48551.65,"maximum":50595.93,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":50595.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":50595.93,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":48551.65,"methodology":"fee schedule"}]}]},{"description":"Open treatment of mandibular fracture; with interdental fixation ","code_information":[{"code":"21462","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of radius AND ulna ","code_information":[{"code":"25575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Optical coherence tomography (OCT) of middle ear, with interpretation and report; unilateral ","code_information":[{"code":"0485T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55.10,"maximum":57.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":55.10,"methodology":"fee schedule"}]}]},{"description":"Osteotomy, iliac, acetabular or innominate bone; with femoral osteotomy and with open reduction of hip ","code_information":[{"code":"27156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level ","code_information":[{"code":"64483","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1357.55,"maximum":1414.71,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1414.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1414.71,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1357.55,"methodology":"fee schedule"}]}]},{"description":"Injection, aflibercept, 1 mg ","code_information":[{"code":"J0178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4.75,"maximum":4.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4.75,"methodology":"fee schedule"}]}]},{"description":"Injection, belinostat, 10 mg ","code_information":[{"code":"J9032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":127.30,"maximum":132.66,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":132.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":132.66,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":127.30,"methodology":"fee schedule"}]}]},{"description":"Injection, crotalidae polyvalent immune fab (ovine), up to 1 gram ","code_information":[{"code":"J0840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":218.50,"maximum":227.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":227.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":227.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":218.50,"methodology":"fee schedule"}]}]},{"description":"Injection, ferric carboxymaltose, 1 mg ","code_information":[{"code":"J1439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":267.90,"maximum":279.18,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":279.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":279.18,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":267.90,"methodology":"fee schedule"}]}]},{"description":"Injection, interferon beta-1a, 1 mcg for intramuscular use ","drug_information":{"unit":"30","type":"GM"},"code_information":[{"code":"959435","type":"CDM"},{"code":"Q3027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":287.85,"maximum":299.97,"gross_charge":2714.01,"discounted_cash":2714.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":299.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":299.97,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":287.85,"methodology":"fee schedule"}]}]},{"description":"Injection, nivolumab, 1 mg ","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"887175","type":"CDM"},{"code":"J9299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":454.10,"maximum":473.22,"gross_charge":4884.91,"discounted_cash":4884.91,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":473.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":473.22,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":454.10,"methodology":"fee schedule"}]}]},{"description":"Injection, romiplostim, 10 micrograms ","code_information":[{"code":"J2796","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":519.65,"maximum":541.53,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":541.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":541.53,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":519.65,"methodology":"fee schedule"}]}]},{"description":"Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; subarachnoid ","code_information":[{"code":"62280","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1357.55,"maximum":1414.71,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1414.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1414.71,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1357.55,"methodology":"fee schedule"}]}]},{"description":"Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate venous access sites; without subcutaneous port or pump (eg, Tesio type catheter) ","code_information":[{"code":"36565","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4721.50,"maximum":4920.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4721.50,"methodology":"fee schedule"}]}]},{"description":"Intravenous injection of agent (eg, fluorescein) to test vascular flow in flap or graft ","code_information":[{"code":"15860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":447.45,"maximum":466.29,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":466.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":466.29,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":447.45,"methodology":"fee schedule"}]}]},{"description":"Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, cervical ","code_information":[{"code":"63020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or multiple ","code_information":[{"code":"38572","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14689.85,"maximum":15308.37,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":14689.85,"methodology":"fee schedule"}]}]},{"description":"Lateral retinacular release, open ","code_information":[{"code":"27425","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s) ","code_information":[{"code":"74181","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":294.50,"maximum":306.90,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":306.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":306.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":294.50,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography without contrast, upper extremity ","code_information":[{"code":"C8935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":607.05,"maximum":632.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":607.05,"methodology":"fee schedule"}]}]},{"description":"Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); ","code_information":[{"code":"19301","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5207.90,"maximum":5427.18,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5427.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5427.18,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5207.90,"methodology":"fee schedule"}]}]},{"description":"Myelography, thoracic, radiological supervision and interpretation ","code_information":[{"code":"72255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179.55,"maximum":187.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, surgical; with concha bullosa resection ","code_information":[{"code":"31240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2467.15,"maximum":2571.03,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2571.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2571.03,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2467.15,"methodology":"fee schedule"}]}]},{"description":"Nipple/areola reconstruction ","code_information":[{"code":"19350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5207.90,"maximum":5427.18,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5427.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5427.18,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5207.90,"methodology":"fee schedule"}]}]},{"description":"Open treatment of acetabular fracture(s) involving anterior and posterior (two) columns, includes T-fracture and both column fracture with complete articular detachment, or single column or transverse ","code_information":[{"code":"27228","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Open treatment of distal radioulnar dislocation, acute or chronic ","code_information":[{"code":"25676","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy and soft tissue repair ","code_information":[{"code":"27524","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Open treatment of ulnar fracture, proximal end (eg, olecranon or coronoid processºes»), includes internal fixation, when performed ","code_information":[{"code":"24685","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Ostectomy of scapula, partial (eg, superior medial angle) ","code_information":[{"code":"23190","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Oxygen uptake, expired gas analysis; rest, indirect (separate procedure) ","code_information":[{"code":"94690","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC ","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1435.50,"maximum":1435.50,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"}]}]},{"description":"Percutaneous skeletal fixation of tarsal bone fracture (except talus and calcaneus), with manipulation, each ","code_information":[{"code":"28456","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Pet imaging, any site, not otherwise specified ","code_information":[{"code":"G0235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":87.40,"maximum":91.08,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":91.08,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":91.08,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":87.40,"methodology":"fee schedule"}]}]},{"description":"Plasma, pooled multiple donor, pathogen reduced, frozen, each unit ","code_information":[{"code":"P9070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":429.40,"maximum":447.48,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":447.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":447.48,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":429.40,"methodology":"fee schedule"}]}]},{"description":"Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection ","code_information":[{"code":"95115","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Psychiatric diagnostic evaluation ","code_information":[{"code":"90791","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101.65,"maximum":105.93,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":105.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":105.93,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":101.65,"methodology":"fee schedule"}]}]},{"description":"Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with contracture release (separate procedure) ","code_information":[{"code":"24149","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination, sacroiliac joints; less than 3 views ","code_information":[{"code":"72200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":294.50,"maximum":306.90,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":306.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":306.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":294.50,"methodology":"fee schedule"}]}]},{"description":"Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, without bone graft ","code_information":[{"code":"21143","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Reconstruction, entire or majority of forehead and/or supraorbital rims; with autograft (includes obtaining grafts) ","code_information":[{"code":"21180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Release or recession, hamstring, proximal ","code_information":[{"code":"27097","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Otoplasty, protruding ear, with or without size reduction ","code_information":[{"code":"69300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91.20,"maximum":95.04,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":91.20,"methodology":"fee schedule"}]}]},{"description":"Percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guida ","code_information":[{"code":"50081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13611.60,"maximum":14184.72,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":14184.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":14184.72,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":13611.60,"methodology":"fee schedule"}]}]},{"description":"Perineoplasty, repair of perineum, nonobstetrical (separate procedure) ","code_information":[{"code":"56810","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4327.25,"maximum":4509.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4327.25,"methodology":"fee schedule"}]}]},{"description":"Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes ","code_information":[{"code":"97750","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":44.65,"maximum":46.53,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":44.65,"methodology":"fee schedule"}]}]},{"description":"Platelets, pheresis, leukocytes reduced, cmv-negative, irradiated, each unit ","code_information":[{"code":"P9053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":84.55,"maximum":88.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":88.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":88.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":84.55,"methodology":"fee schedule"}]}]},{"description":"Preparation of embryo for transfer (any method) ","code_information":[{"code":"89255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":245.10,"maximum":255.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":245.10,"methodology":"fee schedule"}]}]},{"description":"Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; radius ","code_information":[{"code":"25490","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; linear accelerator based ","code_information":[{"code":"77372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209.00,"maximum":217.80,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":217.80,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":217.80,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":209.00,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination, elbow, arthrography, radiological supervision and interpretation ","code_information":[{"code":"73085","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133.00,"maximum":138.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":133.00,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination, single plane body section (eg, tomography), other than with urography ","code_information":[{"code":"76100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination; sternoclavicular joint or joints, minimum of 3 views ","code_information":[{"code":"71130","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179.55,"maximum":187.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia) ","code_information":[{"code":"21247","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Release of extensive scar tissue without detaching extraocular muscle (separate procedure) ","code_information":[{"code":"67343","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage) ","code_information":[{"code":"65435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1335.70,"maximum":1391.94,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1391.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1391.94,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1335.70,"methodology":"fee schedule"}]}]},{"description":"Removal of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array ","code_information":[{"code":"64584","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9405.00,"maximum":9801.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9405.00,"methodology":"fee schedule"}]}]},{"description":"Removal of nephrostomy tube, requiring fluoroscopic guidance (eg, with concurrent indwelling ureteral stent) ","code_information":[{"code":"50389","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":948.10,"maximum":988.02,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":988.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":988.02,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":948.10,"methodology":"fee schedule"}]}]},{"description":"Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; ","code_information":[{"code":"50570","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Repair initial femoral hernia, any age; reducible ","code_information":[{"code":"49550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5246.85,"maximum":5467.77,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5246.85,"methodology":"fee schedule"}]}]},{"description":"Repair of nonunion or malunion, tibia; with sliding graft ","code_information":[{"code":"27722","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm ","code_information":[{"code":"12042","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":570.00,"maximum":594.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":570.00,"methodology":"fee schedule"}]}]},{"description":"Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty within the same vessel, when performed ","code_information":[{"code":"37229","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26488.85,"maximum":27604.17,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27604.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27604.17,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26488.85,"methodology":"fee schedule"}]}]},{"description":"Salivary gland imaging; with serial images ","code_information":[{"code":"78231","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":621.30,"maximum":647.46,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":621.30,"methodology":"fee schedule"}]}]},{"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"}],"standard_charges":[{"setting":"outpatient","minimum":295.45,"maximum":307.89,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":307.89,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":295.45,"methodology":"fee schedule"}]}]},{"description":"Special medical radiation physics consultation ","code_information":[{"code":"77370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209.00,"maximum":217.80,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":217.80,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":217.80,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":209.00,"methodology":"fee schedule"}]}]},{"description":"Stimulus evoked response (eg, measurement of bulbocavernosus reflex latency time) ","code_information":[{"code":"51792","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91.20,"maximum":95.04,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":91.20,"methodology":"fee schedule"}]}]},{"description":"Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; single perforation ","code_information":[{"code":"44602","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5064.45,"maximum":5277.69,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5064.45,"methodology":"fee schedule"}]}]},{"description":"Tenolysis, flexor tendon; palm AND finger, each tendon ","code_information":[{"code":"26442","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Therapeutic apheresis; for red blood cells ","code_information":[{"code":"36512","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2249.60,"maximum":2344.32,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2344.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2344.32,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2249.60,"methodology":"fee schedule"}]}]},{"description":"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular ","code_information":[{"code":"950300","type":"CDM"},{"code":"96372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101.65,"maximum":105.93,"gross_charge":164.08,"discounted_cash":164.08,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":105.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":105.93,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":101.65,"methodology":"fee schedule"}]}]},{"description":"Transection or avulsion of; inferior alveolar nerve by osteotomy ","code_information":[{"code":"64738","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2895.60,"maximum":3017.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2895.60,"methodology":"fee schedule"}]}]},{"description":"Transurethral destruction of prostate tissue; by microwave thermotherapy ","code_information":[{"code":"53850","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ sy ","code_information":[{"code":"76816","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179.55,"maximum":187.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"Unlisted procedure, pancreas ","code_information":[{"code":"48999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1026.00,"maximum":1069.20,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1026.00,"methodology":"fee schedule"}]}]},{"description":"Urethroplasty for second stage hypospadias repair (including urinary diversion); less than 3 cm ","code_information":[{"code":"54308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7277.00,"maximum":7583.40,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7277.00,"methodology":"fee schedule"}]}]},{"description":"Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele ","code_information":[{"code":"58294","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7272.25,"maximum":7578.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7578.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7578.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7272.25,"methodology":"fee schedule"}]}]},{"description":"Whole blood or red blood cells, leukocytes reduced, cmv-negative, each unit ","code_information":[{"code":"P9051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":84.55,"maximum":88.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":88.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":88.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":84.55,"methodology":"fee schedule"}]}]},{"description":"Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument ","code_information":[{"code":"96161","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39.90,"maximum":41.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":39.90,"methodology":"fee schedule"}]}]},{"description":"Anoscopy; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery ","code_information":[{"code":"46610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4028.95,"maximum":4198.59,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4028.95,"methodology":"fee schedule"}]}]},{"description":"Application of short leg splint (calf to foot) ","code_information":[{"code":"29515","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":232.75,"maximum":242.55,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":242.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":242.55,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":232.75,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar; ","code_information":[{"code":"22630","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26668.40,"maximum":27791.28,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26668.40,"methodology":"fee schedule"}]}]},{"description":"Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed (includes arthroscopy) ","code_information":[{"code":"29855","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy with biopsy; interphalangeal joint, each ","code_information":[{"code":"26110","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy; glenohumeral joint, with synovectomy, with or without biopsy ","code_information":[{"code":"23105","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary duct stricture(s) with stent ","code_information":[{"code":"47556","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8345.75,"maximum":8697.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8345.75,"methodology":"fee schedule"}]}]},{"description":"Biopsy, soft tissue of upper arm or elbow area; superficial ","code_information":[{"code":"24065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2319.90,"maximum":2417.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2319.90,"methodology":"fee schedule"}]}]},{"description":"Bone marrow imaging; whole body ","code_information":[{"code":"78104","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2154.60,"maximum":2245.32,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2245.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2245.32,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2154.60,"methodology":"fee schedule"}]}]},{"description":"Capsulectomy or capsulotomy; interphalangeal joint, each joint ","code_information":[{"code":"26525","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Cervicoplasty ","code_information":[{"code":"15819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2824.35,"maximum":2943.27,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2824.35,"methodology":"fee schedule"}]}]},{"description":"Chorionic villus sampling, any method ","code_information":[{"code":"59015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1045.00,"maximum":1089.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1089.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1089.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1045.00,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of metacarpal fracture, single; without manipulation, each bone ","code_information":[{"code":"26600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of talotarsal joint dislocation; requiring anesthesia ","code_information":[{"code":"28575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Colonoscopy through stoma; with transendoscopic balloon dilation ","code_information":[{"code":"44405","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1710.00,"maximum":1782.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1782.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1782.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1710.00,"methodology":"fee schedule"}]}]},{"description":"Complex chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic ","code_information":[{"code":"99487","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":926.25,"maximum":965.25,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":965.25,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":965.25,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":926.25,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections ","code_information":[{"code":"73702","type":"CPT"},{"code":"905537","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":133.00,"maximum":138.60,"gross_charge":11026.40,"discounted_cash":11026.40,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":133.00,"methodology":"fee schedule"}]}]},{"description":"Corpora cavernosa-saphenous vein shunt (priapism operation), unilateral or bilateral ","code_information":[{"code":"54420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with insertion of permanent urethral stent ","code_information":[{"code":"52282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Delay of flap or sectioning of flap (division and inset); at scalp, arms, or legs ","code_information":[{"code":"15610","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2824.35,"maximum":2943.27,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2824.35,"methodology":"fee schedule"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm ","code_information":[{"code":"17281","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":570.00,"maximum":594.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":570.00,"methodology":"fee schedule"}]}]},{"description":"Dilation salivary duct ","code_information":[{"code":"42650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2230.60,"maximum":2324.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2230.60,"methodology":"fee schedule"}]}]},{"description":"Drainage of perivesical or prevesical space abscess ","code_information":[{"code":"51080","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, ","code_information":[{"code":"95981","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":165.30,"maximum":172.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":172.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":172.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":165.30,"methodology":"fee schedule"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) ","code_information":[{"code":"43260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5064.45,"maximum":5277.69,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5064.45,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) ","code_information":[{"code":"43212","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8302.05,"maximum":8651.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8651.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8651.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8302.05,"methodology":"fee schedule"}]}]},{"description":"Excision aural polyp ","code_information":[{"code":"69540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Excision of lacrimal sac (dacryocystectomy) ","code_information":[{"code":"68520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":431.30,"maximum":449.46,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":449.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":449.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":431.30,"methodology":"fee schedule"}]}]},{"description":"Excision of sublingual salivary cyst (ranula) ","code_information":[{"code":"42408","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); ","code_information":[{"code":"25120","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm ","code_information":[{"code":"11646","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Excision, tumor or vascular malformation, soft tissue of hand or finger, subcutaneous; 1.5 cm or greater ","code_information":[{"code":"26111","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2319.90,"maximum":2417.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2319.90,"methodology":"fee schedule"}]}]},{"description":"Exploration, retroperitoneal area with or without biopsy(s) (separate procedure) ","code_information":[{"code":"49010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5246.85,"maximum":5467.77,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5246.85,"methodology":"fee schedule"}]}]},{"description":"Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; first 100 cm2 or part thereof, or 1% of body surface area of infants and children ","code_information":[{"code":"0479T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":863.55,"maximum":899.91,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":863.55,"methodology":"fee schedule"}]}]},{"description":"Germline disorders, gene rearrangement detection by whole genome nextgeneration sequencing, DNA, whole blood, report of specific gene rearrangement(s) ","code_information":[{"code":"0012U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6906.50,"maximum":7197.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7197.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7197.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":6906.50,"methodology":"fee schedule"}]}]},{"description":"High energy neutron radiation treatment delivery, 1 or more isocenter(s) with coplanar or non-coplanar geometry with blocking and/or wedge, and/or compensator(s) ","code_information":[{"code":"77423","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":196.65,"maximum":204.93,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":204.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":204.93,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":196.65,"methodology":"fee schedule"}]}]},{"description":"Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance ","code_information":[{"code":"49083","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1333.80,"maximum":1389.96,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1333.80,"methodology":"fee schedule"}]}]},{"description":"Allogeneic lymphocyte infusions ","code_information":[{"code":"38242","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2249.60,"maximum":2344.32,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2344.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2344.32,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2249.60,"methodology":"fee schedule"}]}]},{"description":"Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic ","code_information":[{"code":"45990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4028.95,"maximum":4198.59,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4028.95,"methodology":"fee schedule"}]}]},{"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":"C5273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6.65,"maximum":6.93,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":6.93,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":6.65,"methodology":"fee schedule"}]}]},{"description":"Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance ","code_information":[{"code":"20600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":430.35,"maximum":448.47,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":448.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":448.47,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":430.35,"methodology":"fee schedule"}]}]},{"description":"Arthroplasty, ankle; revision, total ankle ","code_information":[{"code":"27703","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14000.00,"maximum":21193.92,"payers_information":[{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14000.00,"methodology":"case rate"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion) ","code_information":[{"code":"29885","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, wrist, diagnostic, with or without synovial biopsy (separate procedure) ","code_information":[{"code":"29840","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy; sternoclavicular joint, with synovectomy, with or without biopsy ","code_information":[{"code":"23106","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Biopsy of cornea ","code_information":[{"code":"65410","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Biopsy, soft tissue of shoulder area; deep ","code_information":[{"code":"23066","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Bone length studies (orthoroentgenogram, scanogram) ","code_information":[{"code":"77073","type":"CPT"},{"code":"940343","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"gross_charge":739.30,"discounted_cash":739.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing ","code_information":[{"code":"78494","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":806.55,"maximum":840.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":840.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":840.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":806.55,"methodology":"fee schedule"}]}]},{"description":"Cervical lymphadenectomy (complete) ","code_information":[{"code":"38720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14706.00,"maximum":15325.20,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":15325.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":15325.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":14706.00,"methodology":"fee schedule"}]}]},{"description":"Clitoroplasty for intersex state ","code_information":[{"code":"56805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4327.25,"maximum":4509.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4327.25,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of humeral shaft fracture; without manipulation ","code_information":[{"code":"24500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of proximal tibiofibular joint dislocation; requiring anesthesia ","code_information":[{"code":"27831","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Closure of esophagostomy or fistula; cervical approach ","code_information":[{"code":"43420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"Colpopexy, vaginal; extra-peritoneal approach (sacrospinous, iliococcygeus) ","code_information":[{"code":"57282","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11196.70,"maximum":11668.14,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":11668.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":11668.14,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":11196.70,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions ","code_information":[{"code":"74178","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":607.05,"maximum":632.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":607.05,"methodology":"fee schedule"}]}]},{"description":"Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method ","code_information":[{"code":"30901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Culture of oocyte(s)/embryo(s), less than 4 days; ","code_information":[{"code":"89250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.20,"maximum":15.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":15.20,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) ","code_information":[{"code":"52332","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Decompression fasciotomy, forearm and/or wrist, flexor AND extensor compartment; without debridement of nonviable muscle and/or nerve ","code_information":[{"code":"25024","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint ","code_information":[{"code":"64635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2895.60,"maximum":3017.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2895.60,"methodology":"fee schedule"}]}]},{"description":"Dilation of female urethra, general or conduction (spinal) anesthesia ","code_information":[{"code":"53665","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2952.60,"maximum":3076.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3076.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3076.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2952.60,"methodology":"fee schedule"}]}]},{"description":"Drainage of ovarian abscess; vaginal approach, open ","code_information":[{"code":"58820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4327.25,"maximum":4509.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4327.25,"methodology":"fee schedule"}]}]},{"description":"Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care ","code_information":[{"code":"904903","type":"CDM"},{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":19.95,"maximum":20.79,"gross_charge":166.90,"discounted_cash":166.90,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":20.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":20.79,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":19.95,"methodology":"fee schedule"}]}]},{"description":"Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and ","code_information":[{"code":"62370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":450.30,"maximum":469.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":469.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":469.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":450.30,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transoral; with optical endomicroscopy ","code_information":[{"code":"43252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5064.45,"maximum":5277.69,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5064.45,"methodology":"fee schedule"}]}]},{"description":"Exchange transfusion, blood; newborn ","code_information":[{"code":"36450","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":654.55,"maximum":682.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":682.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":682.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":654.55,"methodology":"fee schedule"}]}]},{"description":"Arthroplasty with prosthetic replacement; distal radius ","code_information":[{"code":"25441","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20337.60,"maximum":21193.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s) ","code_information":[{"code":"29881","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Artificial insemination; intra-cervical ","code_information":[{"code":"58321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":464.55,"maximum":484.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":484.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":484.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":464.55,"methodology":"fee schedule"}]}]},{"description":"Biopsy of lacrimal gland ","code_information":[{"code":"68510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Biopsy, soft tissue of forearm and/or wrist; superficial ","code_information":[{"code":"25065","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2319.90,"maximum":2417.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2319.90,"methodology":"fee schedule"}]}]},{"description":"Blood component or product not otherwise classified ","code_information":[{"code":"P9099","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":106.40,"maximum":110.88,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":110.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":110.88,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":106.40,"methodology":"fee schedule"}]}]},{"description":"Capsulotomy, midfoot; extensive, including posterior talotibial capsulotomy and tendon(s) lengthening (eg, resistant clubfoot deformity) ","code_information":[{"code":"28262","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart ca ","code_information":[{"code":"93460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4782.30,"maximum":4983.66,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4983.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4983.66,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4782.30,"methodology":"fee schedule"}]}]},{"description":"Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug ","code_information":[{"code":"949774","type":"CDM"},{"code":"96413","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101.65,"maximum":105.93,"gross_charge":896.17,"discounted_cash":896.17,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":105.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":105.93,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":101.65,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of distal fibular fracture (lateral malleolus); with manipulation ","code_information":[{"code":"27788","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of proximal fibula or shaft fracture; with manipulation ","code_information":[{"code":"27781","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Closure of laceration, vestibule of mouth; 2.5 cm or less ","code_information":[{"code":"40830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":348.65,"maximum":363.33,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":363.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":363.33,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":348.65,"methodology":"fee schedule"}]}]},{"description":"Compatibility test each unit; immediate spin technique ","code_information":[{"code":"86920","type":"CPT"},{"code":"902392","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":479.75,"maximum":499.95,"gross_charge":241.62,"discounted_cash":241.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":479.75,"methodology":"fee schedule"}]}]},{"description":"Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections ","code_information":[{"code":"74170","type":"CPT"},{"code":"905513","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":179.55,"maximum":187.11,"gross_charge":7275.17,"discounted_cash":7275.17,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; ","code_information":[{"code":"67880","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Cryopreservation; sperm ","code_information":[{"code":"89259","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":245.10,"maximum":255.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":245.10,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with insertion of temporary prostatic implant/stent with fixation/anchor and incisional struts ","code_information":[{"code":"C9769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16567.05,"maximum":17264.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":17264.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":17264.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":16567.05,"methodology":"fee schedule"}]}]},{"description":"Debridement of nail(s) by any method(s); 1 to 5 ","code_information":[{"code":"11720","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91.20,"maximum":95.04,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":95.04,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":91.20,"methodology":"fee schedule"}]}]},{"description":"Destruction by neurolytic agent, with or without radiologic monitoring; superior hypogastric plexus ","code_information":[{"code":"64681","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1357.55,"maximum":1414.71,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1414.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1414.71,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1357.55,"methodology":"fee schedule"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm ","code_information":[{"code":"17286","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":863.55,"maximum":899.91,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":863.55,"methodology":"fee schedule"}]}]},{"description":"Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration, or other continuous renal replacement therapies), with single evaluation by a physician or other qualified health c ","code_information":[{"code":"90945","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":804.65,"maximum":838.53,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":838.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":838.53,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":804.65,"methodology":"fee schedule"}]}]},{"description":"Drainage external ear, abscess or hematoma; simple ","code_information":[{"code":"69000","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique ","code_information":[{"code":"51784","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229.90,"maximum":239.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":239.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":239.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":229.90,"methodology":"fee schedule"}]}]},{"description":"Endoscopic retrograde cholangiopancreatography (ERCP); with removal of calculi/debris from biliary/pancreatic duct(s) ","code_information":[{"code":"43264","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5064.45,"maximum":5277.69,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5064.45,"methodology":"fee schedule"}]}]},{"description":"Esophageal recording of atrial electrogram with or without ventricular electrogram(s); with pacing ","code_information":[{"code":"93616","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1836.35,"maximum":1913.67,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1913.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1913.67,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1836.35,"methodology":"fee schedule"}]}]},{"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":"50435","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2952.60,"maximum":3076.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3076.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3076.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2952.60,"methodology":"fee schedule"}]}]},{"description":"Excision of chest wall tumor including rib(s) ","code_information":[{"code":"21601","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium ","code_information":[{"code":"65400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1335.70,"maximum":1391.94,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1391.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1391.94,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1335.70,"methodology":"fee schedule"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); with allograft ","code_information":[{"code":"25126","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Excision, ischial pressure ulcer, with ostectomy, in preparation for muscle or myocutaneous flap or skin graft closure ","code_information":[{"code":"15946","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2824.35,"maximum":2943.27,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2943.27,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2824.35,"methodology":"fee schedule"}]}]},{"description":"Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm ","code_information":[{"code":"28043","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2319.90,"maximum":2417.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2417.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2319.90,"methodology":"fee schedule"}]}]},{"description":"EXTERNAL PATIENT-ACTIVATED, PHYSICIAN- OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL-PRESCRIBED, ELECTROCARDIOGRAPHIC RHYTHM DERIVED EVENT RECORDER WITHOUT 24-HOUR ATTENDED MONITORING; IN-OFFICE CONNECT ","code_information":[{"code":"0497T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":60.80,"maximum":63.36,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":63.36,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":60.80,"methodology":"fee schedule"}]}]},{"description":"Follicle puncture for oocyte retrieval, any method ","code_information":[{"code":"58970","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1045.00,"maximum":1089.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1089.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1089.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1045.00,"methodology":"fee schedule"}]}]},{"description":"Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist ","code_information":[{"code":"G0118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1308.15,"maximum":1363.23,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1308.15,"methodology":"fee schedule"}]}]},{"description":"Health behavior intervention, individual, face-to-face; initial 30 minutes ","code_information":[{"code":"96158","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure ","code_information":[{"code":"88342","type":"CPT"},{"code":"902836","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":245.10,"maximum":255.42,"gross_charge":588.93,"discounted_cash":588.93,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":245.10,"methodology":"fee schedule"}]}]},{"description":"Incision and drainage of pilonidal cyst; complicated ","code_information":[{"code":"10081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1026.00,"maximum":1069.20,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1026.00,"methodology":"fee schedule"}]}]},{"description":" Trauma Response - Level II Trauma  ","code_information":[{"code":"682","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":2183.10,"maximum":2275.02,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2275.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2275.02,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2183.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_percentage":46.00,"standard_charge_algorithm":"Reimbursement will be 46% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_percentage":27.40,"standard_charge_algorithm":"Reimbursement will be 27.4% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"}]}]},{"description":"Adenoidectomy, primary; age 12 or over ","code_information":[{"code":"42831","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4511.55,"maximum":4701.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4701.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4511.55,"methodology":"fee schedule"}]}]},{"description":"Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours or longer; scanning analysis with report ","code_information":[{"code":"93788","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":229.90,"maximum":239.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":239.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":239.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":229.90,"methodology":"fee schedule"}]}]},{"description":"Anoscopy; with removal of foreign body ","code_information":[{"code":"46608","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1308.15,"maximum":1363.23,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1308.15,"methodology":"fee schedule"}]}]},{"description":"Application of a modality to 1 or more areas; iontophoresis, each 15 minutes ","code_information":[{"code":"97033","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25.65,"maximum":26.73,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":25.65,"methodology":"fee schedule"}]}]},{"description":"Application, cast; finger (eg, contracture) ","code_information":[{"code":"29086","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":232.75,"maximum":242.55,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":242.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":242.55,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":232.75,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments ","code_information":[{"code":"22802","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26668.40,"maximum":27791.28,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26668.40,"methodology":"fee schedule"}]}]},{"description":"Arthroplasty, radial head; ","code_information":[{"code":"24365","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20337.60,"maximum":21193.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Arthrotomy with biopsy; carpometacarpal joint, each ","code_information":[{"code":"26100","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home, with all of the follow ","code_information":[{"code":"99483","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":195.70,"maximum":203.94,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":203.94,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":203.94,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":195.70,"methodology":"fee schedule"}]}]},{"description":"Biopsy or excision of lymph node(s); open, deep cervical node(s) ","code_information":[{"code":"38510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5207.90,"maximum":5427.18,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5427.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5427.18,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5207.90,"methodology":"fee schedule"}]}]},{"description":"Brachytherapy source, non-stranded, high dose rate iridium-192, per source ","code_information":[{"code":"C1717","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6612.95,"maximum":6891.39,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":6891.39,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":6891.39,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":6612.95,"methodology":"fee schedule"}]}]},{"description":"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), each additional lobe (List separately in addition to code for primary procedure) ","code_information":[{"code":"31649","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2467.15,"maximum":2571.03,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2571.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2571.03,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2467.15,"methodology":"fee schedule"}]}]},{"description":"Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantificatio ","code_information":[{"code":"78481","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":806.55,"maximum":840.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":840.51,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":840.51,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":806.55,"methodology":"fee schedule"}]}]},{"description":"Ciliary body destruction; cyclophotocoagulation, endoscopic, without concomitant removal of crystalline lens ","code_information":[{"code":"66711","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3424.75,"maximum":3568.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3424.75,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of hip dislocation, traumatic; requiring anesthesia ","code_information":[{"code":"27252","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Closed treatment of radial and ulnar shaft fractures; without manipulation ","code_information":[{"code":"25560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":339.15,"maximum":353.43,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":353.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":339.15,"methodology":"fee schedule"}]}]},{"description":"Closure of rectovaginal fistula; vaginal or transanal approach ","code_information":[{"code":"57300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4327.25,"maximum":4509.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4327.25,"methodology":"fee schedule"}]}]},{"description":"Colporrhaphy, suture of injury of vagina (nonobstetrical) ","code_information":[{"code":"57200","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4327.25,"maximum":4509.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4327.25,"methodology":"fee schedule"}]}]},{"description":"Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing ","code_information":[{"code":"73206","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":133.00,"maximum":138.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":138.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":133.00,"methodology":"fee schedule"}]}]},{"description":"Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation onc ","code_information":[{"code":"77336","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":209.00,"maximum":217.80,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":217.80,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":217.80,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":209.00,"methodology":"fee schedule"}]}]},{"description":"Correction, cock-up fifth toe, with plastic skin closure (eg, Ruiz-Mora type procedure) ","code_information":[{"code":"28286","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Cystourethroscopy, with steroid injection into stricture ","code_information":[{"code":"52283","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2952.60,"maximum":3076.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3076.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3076.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2952.60,"methodology":"fee schedule"}]}]},{"description":"Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) ","code_information":[{"code":"15780","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm ","code_information":[{"code":"17266","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":570.00,"maximum":594.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":570.00,"methodology":"fee schedule"}]}]},{"description":"Drainage of abscess, cyst, hematoma, vestibule of mouth; simple ","code_information":[{"code":"40800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1026.00,"maximum":1069.20,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1069.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1026.00,"methodology":"fee schedule"}]}]},{"description":"Excision of lacrimal gland tumor; involving osteotomy ","code_information":[{"code":"68550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5453.00,"maximum":5682.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5682.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5682.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5453.00,"methodology":"fee schedule"}]}]},{"description":"Excision of tendon, finger, flexor or extensor, each tendon ","code_information":[{"code":"26180","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area ","code_information":[{"code":"15839","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); 5 cm or greater ","code_information":[{"code":"22901","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Facial moulage sectional ","code_information":[{"code":"D5911","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2287.60,"maximum":2383.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2287.60,"methodology":"fee schedule"}]}]},{"description":"Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit ","code_information":[{"code":"P9017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":247.00,"maximum":257.40,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":257.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":257.40,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":247.00,"methodology":"fee schedule"}]}]},{"description":"Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor ","code_information":[{"code":"38240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":66257.75,"maximum":69047.55,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":69047.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":69047.55,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":66257.75,"methodology":"fee schedule"}]}]},{"description":"Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) ","code_information":[{"code":"77600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":894.90,"maximum":932.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":932.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":932.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":894.90,"methodology":"fee schedule"}]}]},{"description":"Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease ºCOVID-19») vaccine, mRNA-LNP, spike protein, preservative f ","code_information":[{"code":"0073A","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":64.60,"maximum":67.32,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":67.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":67.32,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":64.60,"methodology":"fee schedule"}]}]},{"description":"Incision and drainage, shoulder area; infected bursa ","code_information":[{"code":"23031","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Injection, argatroban, 1 mg (for non-esrd use) ","code_information":[{"code":"J0883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2465.25,"maximum":2569.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2569.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2569.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2465.25,"methodology":"fee schedule"}]}]},{"description":"Injection, cetuximab, 10 mg ","code_information":[{"code":"J9055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":307.80,"maximum":320.76,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":320.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":320.76,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":307.80,"methodology":"fee schedule"}]}]},{"description":"Injection, epoetin beta, 1 microgram, (for non esrd use) ","code_information":[{"code":"J0888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4.75,"maximum":4.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4.75,"methodology":"fee schedule"}]}]},{"description":"Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg ","code_information":[{"code":"J1561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":81.70,"maximum":85.14,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":85.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":85.14,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":81.70,"methodology":"fee schedule"}]}]},{"description":"Injection, ocriplasmin, 0.125 mg ","code_information":[{"code":"J7316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":539.60,"maximum":562.32,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":562.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":562.32,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":539.60,"methodology":"fee schedule"}]}]},{"description":"Injection, rituximab-arrx, biosimilar, (riabni), 10 mg ","code_information":[{"code":"Q5123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":79.80,"maximum":83.16,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":83.16,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":83.16,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":79.80,"methodology":"fee schedule"}]}]},{"description":"Injection, velaglucerase alfa, 100 units ","code_information":[{"code":"J3385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4941.90,"maximum":5149.98,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5149.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5149.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4941.90,"methodology":"fee schedule"}]}]},{"description":"Insertion of drug-eluting implant, including punctal dilation when performed, into lacrimal canaliculus, each ","code_information":[{"code":"68841","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"description":"Insertion of testicular prosthesis (separate procedure) ","code_information":[{"code":"54660","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7277.00,"maximum":7583.40,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7277.00,"methodology":"fee schedule"}]}]},{"description":"Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; ventricular ele ","code_information":[{"code":"0411T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13456.75,"maximum":14023.35,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":14023.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":14023.35,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":13456.75,"methodology":"fee schedule"}]}]},{"description":"Intracapsular cataract extraction with insertion of intraocular lens prosthesis (1 stage procedure) ","code_information":[{"code":"66983","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3424.75,"maximum":3568.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3424.75,"methodology":"fee schedule"}]}]},{"description":"Kidney imaging morphology; with vascular flow ","code_information":[{"code":"78701","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2154.60,"maximum":2245.32,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2245.32,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2245.32,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2154.60,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only ","code_information":[{"code":"43772","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5064.45,"maximum":5277.69,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5064.45,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical; revision or removal of gastric neurostimulator electrodes, antrum ","code_information":[{"code":"43648","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8345.75,"maximum":8697.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8697.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8345.75,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy direct, with or without tracheoscopy; with dilation, subsequent ","code_information":[{"code":"31529","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5109.10,"maximum":5324.22,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5324.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5324.22,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5109.10,"methodology":"fee schedule"}]}]},{"description":"Leuprolide acetate (for depot suspension), 7.5 mg ","drug_information":{"unit":"7.5","type":"ME"},"code_information":[{"code":"951156","type":"CDM"},{"code":"J9217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":92.15,"maximum":96.03,"gross_charge":2336.51,"discounted_cash":2336.51,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":96.03,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":92.15,"methodology":"fee schedule"}]}]},{"description":"Lower esophageal myotomy, transoral (ie, peroral endoscopic myotomy ºPOEM») ","code_information":[{"code":"43497","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5064.45,"maximum":5277.69,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5277.69,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5064.45,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography with contrast, abdomen ","code_information":[{"code":"C8900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":863.55,"maximum":899.91,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":899.91,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":863.55,"methodology":"fee schedule"}]}]},{"description":"Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen ","code_information":[{"code":"36596","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2318.95,"maximum":2416.59,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2416.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2416.59,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2318.95,"methodology":"fee schedule"}]}]},{"description":"Myelography, posterior fossa, radiological supervision and interpretation ","code_information":[{"code":"70010","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Neuroplasty, major peripheral nerve, arm or leg, open; lumbar plexus ","code_information":[{"code":"64714","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2895.60,"maximum":3017.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3017.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2895.60,"methodology":"fee schedule"}]}]},{"description":"Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach ","code_information":[{"code":"58615","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4327.25,"maximum":4509.45,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4509.45,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4327.25,"methodology":"fee schedule"}]}]},{"description":"Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of both tibia and fibula ","code_information":[{"code":"27828","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20337.60,"maximum":21193.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining graft) ","code_information":[{"code":"21395","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"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"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Osteopathic manipulative treatment (OMT); 7-8 body regions involved ","code_information":[{"code":"98928","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39.90,"maximum":41.58,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":41.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":39.90,"methodology":"fee schedule"}]}]},{"description":"Patch or application test(s) (specify number of tests) ","code_information":[{"code":"95044","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":55.10,"maximum":57.42,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":55.10,"methodology":"fee schedule"}]}]},{"description":"Percutaneous skeletal fixation of femoral fracture, proximal end, neck ","code_information":[{"code":"27235","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Electroencephalogram (EEG); including recording awake and asleep ","code_information":[{"code":"901386","type":"CDM"},{"code":"95819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1517.15,"maximum":1581.03,"gross_charge":2139.86,"discounted_cash":2139.86,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1581.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1581.03,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1517.15,"methodology":"fee schedule"}]}]},{"description":"Esophagogastroduodenoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) ","code_information":[{"code":"0652T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1333.80,"maximum":1389.96,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1333.80,"methodology":"fee schedule"}]}]},{"description":"Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; thoracic ","code_information":[{"code":"22101","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic saline, enzyme) or mechanical means (eg, catheter) including radiologic localization (includes contrast when administe ","code_information":[{"code":"62264","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1357.55,"maximum":1414.71,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1414.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1414.71,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1357.55,"methodology":"fee schedule"}]}]},{"description":"Echocardiography, transesophageal (TEE) for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of ( ","code_information":[{"code":"93318","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":796.10,"maximum":829.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":829.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":829.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":796.10,"methodology":"fee schedule"}]}]},{"description":"Endovascular venous arterialization, tibial or peroneal vein, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ul ","code_information":[{"code":"0620T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26488.85,"maximum":27604.17,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27604.17,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27604.17,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26488.85,"methodology":"fee schedule"}]}]},{"description":"Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter) ","code_information":[{"code":"43220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2678.05,"maximum":2790.81,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2790.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2790.81,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2678.05,"methodology":"fee schedule"}]}]},{"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"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Excision of penile plaque (Peyronie disease); with graft greater than 5 cm in length ","code_information":[{"code":"54112","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13611.60,"maximum":14184.72,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":14184.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":14184.72,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":13611.60,"methodology":"fee schedule"}]}]},{"description":"Excision or curettage of bone cyst or benign tumor of clavicle or scapula; ","code_information":[{"code":"23140","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Excision or fulguration; urethral prolapse ","code_information":[{"code":"53275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular); 1.5 cm or greater ","code_information":[{"code":"28041","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Exploration of epididymis, with or without biopsy ","code_information":[{"code":"54865","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5071.10,"maximum":5284.62,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5284.62,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5071.10,"methodology":"fee schedule"}]}]},{"description":"Fetal biophysical profile; without non-stress testing ","code_information":[{"code":"76819","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":179.55,"maximum":187.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":187.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":179.55,"methodology":"fee schedule"}]}]},{"description":"Fusion in opposition, thumb, with autogenous graft (includes obtaining graft) ","code_information":[{"code":"26820","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Hepatitis B immune globulin (HBIg), human, for intramuscular use ","code_information":[{"code":"90371","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":81.70,"maximum":85.14,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":85.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":85.14,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":81.70,"methodology":"fee schedule"}]}]},{"description":"Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming ","code_information":[{"code":"62362","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28109.55,"maximum":29293.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":29293.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":29293.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":28109.55,"methodology":"fee schedule"}]}]},{"description":"Incision and drainage of vaginal hematoma; obstetrical/postpartum ","code_information":[{"code":"57022","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Injection procedure; radioactive tracer for identification of sentinel node ","code_information":[{"code":"38792","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":621.30,"maximum":647.46,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":647.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":621.30,"methodology":"fee schedule"}]}]},{"description":"Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, i ","code_information":[{"code":"62323","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1046.90,"maximum":1090.98,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1090.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1090.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1046.90,"methodology":"fee schedule"}]}]},{"description":"Injection, cangrelor, 1 mg ","code_information":[{"code":"C9460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":68.40,"maximum":71.28,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":71.28,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":68.40,"methodology":"fee schedule"}]}]},{"description":"Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram ","code_information":[{"code":"Q5110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":97.85,"maximum":101.97,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":101.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":101.97,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":97.85,"methodology":"fee schedule"}]}]},{"description":"Injection, melphalan (evomela), 1 mg ","code_information":[{"code":"J9246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":259.35,"maximum":270.27,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":270.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":270.27,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":259.35,"methodology":"fee schedule"}]}]},{"description":"Injection, tagraxofusp-erzs, 10 micrograms ","code_information":[{"code":"J9269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4.75,"maximum":4.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4.75,"methodology":"fee schedule"}]}]},{"description":"Injection, triptorelin pamoate, 3.75 mg ","code_information":[{"code":"J3315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4.75,"maximum":4.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4.75,"methodology":"fee schedule"}]}]},{"description":"Insertion of tunneled centrally inserted central venous access device with subcutaneous pump ","code_information":[{"code":"36563","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7865.05,"maximum":8196.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7865.05,"methodology":"fee schedule"}]}]},{"description":"Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient en ","code_information":[{"code":"93261","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Introduction of long gastrointestinal tube (eg, Miller-Abbott) (separate procedure) ","code_information":[{"code":"44500","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1333.80,"maximum":1389.96,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1389.96,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1333.80,"methodology":"fee schedule"}]}]},{"description":"Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band), including cruroplasty when performed ","code_information":[{"code":"43284","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14689.85,"maximum":15308.37,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":15308.37,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":14689.85,"methodology":"fee schedule"}]}]},{"description":"Laryngoscopy, flexible; diagnostic ","code_information":[{"code":"31575","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":270.75,"maximum":282.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":282.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":282.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":270.75,"methodology":"fee schedule"}]}]},{"description":"Ligation of femoral vein ","code_information":[{"code":"37650","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4721.50,"maximum":4920.30,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4920.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4721.50,"methodology":"fee schedule"}]}]},{"description":"Lysis intranasal synechia ","code_information":[{"code":"30560","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":745.75,"maximum":777.15,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":777.15,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":777.15,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":745.75,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography without contrast followed by with contrast, upper extremity ","code_information":[{"code":"C8936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy ","code_information":[{"code":"19302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9127.60,"maximum":9511.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":9511.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":9511.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9127.60,"methodology":"fee schedule"}]}]},{"description":"Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium ","code_information":[{"code":"31296","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9604.50,"maximum":10008.90,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10008.90,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10008.90,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9604.50,"methodology":"fee schedule"}]}]},{"description":"Nerve graft (includes obtaining graft), single strand, arm or leg; up to 4 cm length ","code_information":[{"code":"64892","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":9405.00,"maximum":9801.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":9801.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9405.00,"methodology":"fee schedule"}]}]},{"description":"Omentectomy, epiploectomy, resection of omentum (separate procedure) ","code_information":[{"code":"49255","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5246.85,"maximum":5467.77,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5467.77,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5246.85,"methodology":"fee schedule"}]}]},{"description":"Open treatment of hip dislocation, traumatic, with acetabular wall and femoral head fracture, with or without internal or external fixation ","code_information":[{"code":"27254","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Open treatment of slipped femoral epiphysis; closed manipulation with single or multiple pinning ","code_information":[{"code":"27178","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with removal of lesion ","code_information":[{"code":"67420","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5453.00,"maximum":5682.60,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":5682.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":5682.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":5453.00,"methodology":"fee schedule"}]}]},{"description":"Osteotomy, clavicle, with or without internal fixation; ","code_information":[{"code":"23480","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Paracentesis of anterior chamber of eye (separate procedure); with removal of blood, with or without irrigation and/or air injection ","code_information":[{"code":"65815","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3424.75,"maximum":3568.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3424.75,"methodology":"fee schedule"}]}]},{"description":"Periorbital osteotomies for orbital hypertelorism, with bone grafts; extracranial approach ","code_information":[{"code":"21260","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Placement of seton ","code_information":[{"code":"46020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4028.95,"maximum":4198.59,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4198.59,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4028.95,"methodology":"fee schedule"}]}]},{"description":"Platelets, leukocytes reduced, each unit ","code_information":[{"code":"P9031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":626.05,"maximum":652.41,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":652.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":652.41,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":626.05,"methodology":"fee schedule"}]}]},{"description":"Proctosigmoidoscopy, rigid; with dilation (eg, balloon, guide wire, bougie) ","code_information":[{"code":"45303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1710.00,"maximum":1782.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1782.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1782.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1710.00,"methodology":"fee schedule"}]}]},{"description":"Punch graft for hair transplant; 1 to 15 punch grafts ","code_information":[{"code":"15775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":570.00,"maximum":594.00,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":570.00,"methodology":"fee schedule"}]}]},{"description":"Radical excision external auditory canal lesion; without neck dissection ","code_information":[{"code":"69150","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3910.20,"maximum":4074.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4074.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3910.20,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination, elbow; complete, minimum of 3 views ","code_information":[{"code":"73080","type":"CPT"},{"code":"905906","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":607.05,"maximum":632.61,"gross_charge":464.29,"discounted_cash":464.29,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":607.05,"methodology":"fee schedule"}]}]},{"description":"Radiologic examination, spine, cervical; 6 or more views ","code_information":[{"code":"72052","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":607.05,"maximum":632.61,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":632.61,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":607.05,"methodology":"fee schedule"}]}]},{"description":"Recement unilat space maint ","code_information":[{"code":"D1553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2287.60,"maximum":2383.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2383.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2287.60,"methodology":"fee schedule"}]}]},{"description":"Reinsertion of spinal fixation device ","code_information":[{"code":"22849","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26668.40,"maximum":27791.28,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27791.28,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26668.40,"methodology":"fee schedule"}]}]},{"description":"Removal foreign body, intranasal; office type procedure ","code_information":[{"code":"30300","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":185.25,"maximum":193.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":193.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":185.25,"methodology":"fee schedule"}]}]},{"description":"Removal of implanted material, posterior segment; intraocular ","code_information":[{"code":"67121","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3424.75,"maximum":3568.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3424.75,"methodology":"fee schedule"}]}]},{"description":"Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar ","code_information":[{"code":"22865","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":20337.60,"maximum":21193.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21193.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20337.60,"methodology":"fee schedule"}]}]},{"description":"Repair medial collateral ligament, elbow, with local tissue ","code_information":[{"code":"24345","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Repair of nonunion or malunion, radius OR ulna; without graft (eg, compression technique) ","code_information":[{"code":"25400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Repair, extensor tendon, finger, primary or secondary; without free graft, each tendon ","code_information":[{"code":"26418","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2297.10,"maximum":2393.82,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2393.82,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2297.10,"methodology":"fee schedule"}]}]},{"description":"Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary (excludes rotator cuff) ","code_information":[{"code":"24341","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure) ","code_information":[{"code":"66825","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3424.75,"maximum":3568.95,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3568.95,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3424.75,"methodology":"fee schedule"}]}]},{"description":"Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure ","code_information":[{"code":"66250","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3300.30,"maximum":3439.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3439.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":3300.30,"methodology":"fee schedule"}]}]},{"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"}],"standard_charges":[{"setting":"outpatient","minimum":7865.05,"maximum":8196.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7865.05,"methodology":"fee schedule"}]}]},{"description":"Sigmoidoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed ","code_information":[{"code":"45337","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1308.15,"maximum":1363.23,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1363.23,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1308.15,"methodology":"fee schedule"}]}]},{"description":"Special teletherapy port plan, particles, hemibody, total body ","code_information":[{"code":"77321","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":557.65,"maximum":581.13,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":581.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":581.13,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":557.65,"methodology":"fee schedule"}]}]},{"description":"Strapping; ankle and/or foot ","code_information":[{"code":"29540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":232.75,"maximum":242.55,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":242.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":242.55,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":232.75,"methodology":"fee schedule"}]}]},{"description":"Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method ","code_information":[{"code":"G0416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":"Synovectomy, tendon sheath, foot; extensor ","code_information":[{"code":"28088","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4670.20,"maximum":4866.84,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":4866.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":4670.20,"methodology":"fee schedule"}]}]},{"description":"Temporomandibular joint arthrography, radiological supervision and interpretation ","code_information":[{"code":"70332","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":379.05,"maximum":395.01,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":395.01,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":379.05,"methodology":"fee schedule"}]}]},{"description":"Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary pro ","code_information":[{"code":"96375","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":101.65,"maximum":105.93,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":105.93,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":105.93,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":101.65,"methodology":"fee schedule"}]}]},{"description":"Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any method, including radiological supervision and interpretation, initial treatment day ","code_information":[{"code":"37211","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7865.05,"maximum":8196.21,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8196.21,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7865.05,"methodology":"fee schedule"}]}]},{"description":"Transplant preparation of hematopoietic progenitor cells; platelet depletion ","code_information":[{"code":"38213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":654.55,"maximum":682.11,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":682.11,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":682.11,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":654.55,"methodology":"fee schedule"}]}]},{"description":"Transurethral radiofrequency micro-remodeling of the female bladder neck and proximal urethra for stress urinary incontinence ","code_information":[{"code":"53860","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2952.60,"maximum":3076.92,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":3076.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":3076.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2952.60,"methodology":"fee schedule"}]}]},{"description":"Tympanostomy (requiring insertion of ventilating tube), using an automated tube delivery system, iontophoresis local anesthesia ","code_information":[{"code":"0583T","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2230.60,"maximum":2324.52,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2324.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2230.60,"methodology":"fee schedule"}]}]},{"description":"Unlisted procedure, female genital system (nonobstetrical) ","code_information":[{"code":"58999","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":280.25,"maximum":292.05,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":292.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":292.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":280.25,"methodology":"fee schedule"}]}]},{"description":"Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy ","code_information":[{"code":"50976","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7277.00,"maximum":7583.40,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7583.40,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7277.00,"methodology":"fee schedule"}]}]},{"description":"Ventilating tube removal requiring general anesthesia ","code_information":[{"code":"69424","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8388.50,"maximum":8741.70,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8741.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8388.50,"methodology":"fee schedule"}]}]},{"description":"Wedge resection or bisection of ovary, unilateral or bilateral ","code_information":[{"code":"58920","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11196.70,"maximum":11668.14,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":11668.14,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":11668.14,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":11196.70,"methodology":"fee schedule"}]}]},{"description":"Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes ","code_information":[{"code":"G0446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":42.75,"maximum":44.55,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":44.55,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":42.75,"methodology":"fee schedule"}]}]},{"description":"Application of multi-layer compression system; upper arm, forearm, hand, and fingers ","code_information":[{"code":"29584","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":232.75,"maximum":242.55,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":242.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":242.55,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":232.75,"methodology":"fee schedule"}]}]},{"description":"Arthrodesis, glenohumeral joint; ","code_information":[{"code":"23800","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10330.30,"maximum":10765.26,"payers_information":[{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10765.26,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":10330.30,"methodology":"fee schedule"}]}]},{"description":" Emergency Room Urgent Care  ","code_information":[{"code":"456","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":300.00,"maximum":875.00,"payers_information":[{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":795.00,"methodology":"case rate"},{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":300.00,"methodology":"case rate"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":875.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":630.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":405.00,"methodology":"case rate"}]}]},{"description":"OTHER DRUG ABUSE AND DEPENDENCE ","code_information":[{"code":"0843","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":266.76,"maximum":266.76,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":266.76,"methodology":"fee schedule"}]}]},{"description":"OTHER HEPATOBILIARY SYSTEM DIAGNOSES ","code_information":[{"code":"0639","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":180.36,"maximum":180.36,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":180.36,"methodology":"fee schedule"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES ","code_information":[{"code":"0660","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":164.16,"maximum":164.16,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":164.16,"methodology":"fee schedule"}]}]},{"description":"PAIN RELATED DIAGNOSES ","code_information":[{"code":"0663","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":149.04,"maximum":149.04,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":149.04,"methodology":"fee schedule"}]}]},{"description":"PERCUTANEOUS INTRA-ABDOMINAL OR INTRATHORACIC VASCULAR PROCEDURES ","code_information":[{"code":"0122","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":17850.24,"maximum":17850.24,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":17850.24,"methodology":"fee schedule"}]}]},{"description":"PET SCANS ","code_information":[{"code":"0290","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":1306.80,"maximum":1306.80,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":1306.80,"methodology":"fee schedule"}]}]},{"description":"PRETERM LABOR DIAGNOSES ","code_information":[{"code":"0762","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":368.28,"maximum":368.28,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":368.28,"methodology":"fee schedule"}]}]},{"description":"PULMONARY INFECTION DIAGNOSES INCLUDING PNEUMONIA ","code_information":[{"code":"0581","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":286.20,"maximum":286.20,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":286.20,"methodology":"fee schedule"}]}]},{"description":"REPRODUCTIVE PATHOLOGY TESTS ","code_information":[{"code":"0157","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":72.36,"maximum":72.36,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":72.36,"methodology":"fee schedule"}]}]},{"description":"SCIATICA AND LOW BACK PAIN ","code_information":[{"code":"0658","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":180.36,"maximum":180.36,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":180.36,"methodology":"fee schedule"}]}]},{"description":"SKIN AND CONNECTIVE TISSUE GRAFTING AND FLAP PROCEDURES ","code_information":[{"code":"0056","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":1954.80,"maximum":1954.80,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":1954.80,"methodology":"fee schedule"}]}]},{"description":"SUPERFICIAL NEEDLE BIOPSY AND ASPIRATION ","code_information":[{"code":"0002","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":629.64,"maximum":629.64,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":629.64,"methodology":"fee schedule"}]}]},{"description":"THYROID AND PARATHYROID PROCEDURES ","code_information":[{"code":"0263","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":4218.48,"maximum":4218.48,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":4218.48,"methodology":"fee schedule"}]}]},{"description":"URINALYSIS ","code_information":[{"code":"0410","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":2.16,"maximum":2.16,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":2.16,"methodology":"fee schedule"}]}]},{"description":"VIRAL ILLNESS ","code_information":[{"code":"0808","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":236.52,"maximum":236.52,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":236.52,"methodology":"fee schedule"}]}]},{"description":" Room & Board - Three and Four Beds Psychiatriac  ","code_information":[{"code":"134","type":"RC"}],"standard_charges":[{"setting":"inpatient","minimum":900.00,"maximum":900.00,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":900.00,"methodology":"per diem"}]}]},{"description":"ACUTE AND SUBACUTE ENDOCARDITIS ","code_information":[{"code":"0608","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":137.16,"maximum":137.16,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":137.16,"methodology":"fee schedule"}]}]},{"description":"ADAPTIVE BEHAVIORAL HEALTH TREATMENT SERVICES ","code_information":[{"code":"0309","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":47.52,"maximum":47.52,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":47.52,"methodology":"fee schedule"}]}]},{"description":"AFTEREFFECTS OF CEREBROVASCULAR ACCIDENT ","code_information":[{"code":"0533","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":137.16,"maximum":137.16,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":137.16,"methodology":"fee schedule"}]}]},{"description":"AMBULATORY PATIENT MONITORING AND RELATED ASSESSMENTS ","code_information":[{"code":"0418","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":68.04,"maximum":68.04,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":68.04,"methodology":"fee schedule"}]}]},{"description":"ANTEPARTUM PROCEDURES ","code_information":[{"code":"0178","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":649.08,"maximum":649.08,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":649.08,"methodology":"fee schedule"}]}]},{"description":"BEHAVIORAL AND SUBSTANCE ABUSE PARTIAL HOSPITALIZATION PROGRAM ","code_information":[{"code":"0312","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":303.48,"maximum":303.48,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":303.48,"methodology":"fee schedule"}]}]},{"description":"BONE MARROW BIOPSIES ","code_information":[{"code":"0124","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":1185.84,"maximum":1185.84,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":1185.84,"methodology":"fee schedule"}]}]},{"description":"CARDIAC CATHETERIZATION PROCEDURES ","code_information":[{"code":"0084","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":2350.08,"maximum":2350.08,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":2350.08,"methodology":"fee schedule"}]}]},{"description":"CAST APPLICATION OR REPLACEMENT ","code_information":[{"code":"0039","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":187.92,"maximum":187.92,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":187.92,"methodology":"fee schedule"}]}]},{"description":"CHILD PREVENTIVE MEDICINE ","code_information":[{"code":"0877","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":130.68,"maximum":130.68,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":130.68,"methodology":"fee schedule"}]}]},{"description":"CLASS I THERAPEUTIC RADIOPHARMACEUTICALS ","code_information":[{"code":"0243","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":22.68,"maximum":22.68,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":22.68,"methodology":"fee schedule"}]}]},{"description":"CLASS III PHARMACOTHERAPY ","code_information":[{"code":"0437","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":158.76,"maximum":158.76,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":158.76,"methodology":"fee schedule"}]}]},{"description":"CLASS VI CHEMOTHERAPY DRUGS ","code_information":[{"code":"0441","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":699.84,"maximum":699.84,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":699.84,"methodology":"fee schedule"}]}]},{"description":"CLASS XIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY ","code_information":[{"code":"0465","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":16046.64,"maximum":16046.64,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":16046.64,"methodology":"fee schedule"}]}]},{"description":"COMPLEX KIDNEY AND URINARY TRACT INFECTIONS ","code_information":[{"code":"0723","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":238.68,"maximum":238.68,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":238.68,"methodology":"fee schedule"}]}]},{"description":"CONSTIPATION ","code_information":[{"code":"0630","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":201.96,"maximum":201.96,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":201.96,"methodology":"fee schedule"}]}]},{"description":"CVA AND PRECEREBRAL OCCLUSION W INFARCT ","code_information":[{"code":"0535","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":210.60,"maximum":210.60,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":210.60,"methodology":"fee schedule"}]}]},{"description":"DEPRESSION EXCEPT MAJOR DEPRESSIVE DIAGNOSES ","code_information":[{"code":"0824","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":128.52,"maximum":128.52,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":128.52,"methodology":"fee schedule"}]}]},{"description":"DIAGNOSTIC DENTAL PROCEDURES ","code_information":[{"code":"0376","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":105.84,"maximum":105.84,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":105.84,"methodology":"fee schedule"}]}]},{"description":"ECTOPIC PREGNANCY PROCEDURES ","code_information":[{"code":"0179","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":3700.08,"maximum":3700.08,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":3700.08,"methodology":"fee schedule"}]}]},{"description":"ESOPHAGITIS AND OTHER ESOPHAGEAL DIAGNOSES ","code_information":[{"code":"0623","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":164.16,"maximum":164.16,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":164.16,"methodology":"fee schedule"}]}]},{"description":"FALSE LABOR ","code_information":[{"code":"0764","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":201.96,"maximum":201.96,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":201.96,"methodology":"fee schedule"}]}]},{"description":"FRACTURES, DISLOCATIONS, OTHER INJURIES - UPPER EXTREMITY INCLUDING SHOULDER ","code_information":[{"code":"0647","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":264.60,"maximum":264.60,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":264.60,"methodology":"fee schedule"}]}]},{"description":"GENETIC COUNSELING ","code_information":[{"code":"0882","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":144.72,"maximum":144.72,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":144.72,"methodology":"fee schedule"}]}]},{"description":"HEAD TRAUMA WITH OR WITHOUT LOC/COMA LESS THAN 1 HR ","code_information":[{"code":"0532","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":192.24,"maximum":192.24,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":192.24,"methodology":"fee schedule"}]}]},{"description":"HYPERTENSION ","code_information":[{"code":"0599","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":137.16,"maximum":137.16,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":137.16,"methodology":"fee schedule"}]}]},{"description":"INSERTION OR REMOVAL OF DRUG DELIVERY DEVICE ","code_information":[{"code":"0307","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":321.84,"maximum":321.84,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":321.84,"methodology":"fee schedule"}]}]},{"description":"INTRAOPERATIVE, POST-OPERATIVE OR POST-TRAUMATIC INFECTIONS AND COMPLICATIONS ","code_information":[{"code":"0806","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":197.64,"maximum":197.64,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":197.64,"methodology":"fee schedule"}]}]},{"description":"LEVEL I ARTHROPLASTY ","code_information":[{"code":"0046","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":3466.80,"maximum":3466.80,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":3466.80,"methodology":"fee schedule"}]}]},{"description":"LEVEL I COMPLEX LABORATORY, MOLECULAR PATHOLOGY AND GENETIC TESTS ","code_information":[{"code":"0385","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":43.20,"maximum":43.20,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":43.20,"methodology":"fee schedule"}]}]},{"description":"LEVEL I DEVICE PLACEMENT FOR RADIATION THERAPY ","code_information":[{"code":"0334","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":819.72,"maximum":819.72,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":819.72,"methodology":"fee schedule"}]}]},{"description":"LEVEL I ESOPHAGEAL AND GASTRIC SURGICAL PROCEDURES ","code_information":[{"code":"0125","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":3209.76,"maximum":3209.76,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":3209.76,"methodology":"fee schedule"}]}]},{"description":"LEVEL I HIP AND FEMUR PROCEDURES ","code_information":[{"code":"0027","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":3417.12,"maximum":3417.12,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":3417.12,"methodology":"fee schedule"}]}]},{"description":"LEVEL I LOWER AIRWAY ENDOSCOPY ","code_information":[{"code":"0064","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":1638.36,"maximum":1638.36,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":1638.36,"methodology":"fee schedule"}]}]},{"description":"LEVEL I ORTHODONTICS ","code_information":[{"code":"0371","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":2345.76,"maximum":2345.76,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":2345.76,"methodology":"fee schedule"}]}]},{"description":"LEVEL I PERIPHERAL NERVE PROCEDURES ","code_information":[{"code":"0217","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":1372.68,"maximum":1372.68,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":1372.68,"methodology":"fee schedule"}]}]},{"description":"LEVEL I SKIN EXCISIONS, BIOPSIES, AND REPAIRS ","code_information":[{"code":"0009","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":443.88,"maximum":443.88,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":443.88,"methodology":"fee schedule"}]}]},{"description":"LEVEL I VARICOSE VEIN AND RELATED PROCEDURES ","code_information":[{"code":"0090","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":564.84,"maximum":564.84,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":564.84,"methodology":"fee schedule"}]}]},{"description":"LEVEL II BLOOD AND TISSUE TYPING TESTS ","code_information":[{"code":"0393","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":25.92,"maximum":25.92,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":25.92,"methodology":"fee schedule"}]}]},{"description":"LEVEL II CORNEAL AND OTHER ANTERIOR SURFACE EYE PROCEDURES ","code_information":[{"code":"0248","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":3243.24,"maximum":3243.24,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":3243.24,"methodology":"fee schedule"}]}]},{"description":"LEVEL II EAR, NOSE, MOUTH AND THROAT PROCEDURES ","code_information":[{"code":"0253","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":2903.04,"maximum":2903.04,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":2903.04,"methodology":"fee schedule"}]}]},{"description":"LEVEL II FOOT PROCEDURES ","code_information":[{"code":"0036","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":5220.72,"maximum":5220.72,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":5220.72,"methodology":"fee schedule"}]}]},{"description":"LEVEL II IMMUNOLOGY TESTS ","code_information":[{"code":"0395","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":30.24,"maximum":30.24,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":30.24,"methodology":"fee schedule"}]}]},{"description":"LEVEL II MAXILLOFACIAL PROSTHETICS ","code_information":[{"code":"0360","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":302.40,"maximum":302.40,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":302.40,"methodology":"fee schedule"}]}]},{"description":"LEVEL II PENILE PROCEDURES ","code_information":[{"code":"0187","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":3186.00,"maximum":3186.00,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":3186.00,"methodology":"fee schedule"}]}]},{"description":"LEVEL II PROSTHODONTICS, FIXED ","code_information":[{"code":"0354","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":384.48,"maximum":384.48,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":384.48,"methodology":"fee schedule"}]}]},{"description":"LEVEL II SPINE PROCEDURES ","code_information":[{"code":"0029","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":10234.08,"maximum":10234.08,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":10234.08,"methodology":"fee schedule"}]}]},{"description":"LEVEL III CHEMISTRY TESTS ","code_information":[{"code":"0384","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":109.08,"maximum":109.08,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":109.08,"methodology":"fee schedule"}]}]},{"description":"LEVEL III ORAL SURGERY PROCEDURES ","code_information":[{"code":"0369","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":3942.00,"maximum":3942.00,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":3942.00,"methodology":"fee schedule"}]}]},{"description":"LEVEL III SPINE PROCEDURES ","code_information":[{"code":"0057","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":13110.12,"maximum":13110.12,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":13110.12,"methodology":"fee schedule"}]}]},{"description":"MAGNETIC RESONANCE IMAGING WITH CONTRAST ","code_information":[{"code":"0295","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":444.96,"maximum":444.96,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":444.96,"methodology":"fee schedule"}]}]},{"description":"MAJOR OPEN CORONARY ARTERY PROCEDURES INCLUDING CABG ","code_information":[{"code":"0104","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":21555.72,"maximum":21555.72,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":21555.72,"methodology":"fee schedule"}]}]},{"description":"MALFUNCTION, REACTION, COMPLICATION OF NEUROLOGICAL DEVICE OR PROC ","code_information":[{"code":"0537","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":212.76,"maximum":212.76,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":212.76,"methodology":"fee schedule"}]}]},{"description":"MAMMOGRAPHY AND OTHER RELATED PROCEDURES ","code_information":[{"code":"0286","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":49.68,"maximum":49.68,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":49.68,"methodology":"fee schedule"}]}]},{"description":"MINOR GASTROINTESTINAL PROCEDURES INCLUDING TUBE INSERTION OR PLACEMENT ","code_information":[{"code":"0130","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":670.68,"maximum":670.68,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":670.68,"methodology":"fee schedule"}]}]},{"description":"MULTIPLE SCLEROSIS AND OTHER DEMYELINATING DISEASES ","code_information":[{"code":"0523","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":123.12,"maximum":123.12,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":123.12,"methodology":"fee schedule"}]}]},{"description":"NERVE AND MUSCLE TESTS ","code_information":[{"code":"0213","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":136.08,"maximum":136.08,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":136.08,"methodology":"fee schedule"}]}]},{"description":"NUTRITION THERAPY ","code_information":[{"code":"0118","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":195.48,"maximum":195.48,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":195.48,"methodology":"fee schedule"}]}]},{"description":"OCULAR RECONSTRUCTIVE PROCEDURES W OR W/O OCULAR DEVICE ","code_information":[{"code":"0241","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":2785.32,"maximum":2785.32,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":2785.32,"methodology":"fee schedule"}]}]},{"description":"OSTEOPOROSIS ","code_information":[{"code":"0662","type":"EAPG"}],"standard_charges":[{"setting":"outpatient","minimum":126.36,"maximum":126.36,"payers_information":[{"payer_name":"Colorado Access","plan_name":"MCD","standard_charge_dollar":126.36,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M > 36.35 ","code_information":[{"code":"118","type":"RC"},{"code":"A1101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20034.04,"maximum":20034.04,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20034.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20034.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20034.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20034.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20034.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20034.04,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":20034.04,"methodology":"fee schedule"}]}]},{"description":"BURNS; M > 0 ","code_information":[{"code":"148","type":"RC"},{"code":"C2101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22991.69,"maximum":22991.69,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":22991.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":22991.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":22991.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":22991.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":22991.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":22991.69,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":22991.69,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M > 31.15 & M < 38.55 ","code_information":[{"code":"128","type":"RC"},{"code":"D1403","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25790.50,"maximum":25790.50,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25790.50,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M < 28.15 ","code_information":[{"code":"128","type":"RC"},{"code":"A0704","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31679.67,"maximum":31679.67,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":31679.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":31679.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":31679.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":31679.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":31679.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":31679.67,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":31679.67,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 42.15 ","code_information":[{"code":"138","type":"RC"},{"code":"A0701","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":17074.37,"maximum":17074.37,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17074.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17074.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17074.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17074.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17074.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17074.37,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17074.37,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA NO BRAIN OR SPINAL CORD INJURY; M ","code_information":[{"code":"158","type":"RC"},{"code":"A1702","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21815.46,"maximum":21815.46,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":21815.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":21815.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":21815.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":21815.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":21815.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":21815.46,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":21815.46,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CODE IN ","code_information":[{"code":"118","type":"RC"},{"code":"B1804","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":40184.69,"maximum":40184.69,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":40184.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":40184.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":40184.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":40184.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":40184.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":40184.69,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":40184.69,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA,NO BRAIN OR SPINAL CORD INJU ","code_information":[{"code":"118","type":"RC"},{"code":"D1704","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32339.16,"maximum":32339.16,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":32339.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":32339.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":32339.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":32339.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":32339.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":32339.16,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":32339.16,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 38.75 & M < 49.15 ","code_information":[{"code":"118","type":"RC"},{"code":"B2002","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":29592.63,"maximum":29592.63,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":29592.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":29592.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":29592.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":29592.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":29592.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":29592.63,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":29592.63,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M < 25.85 ","code_information":[{"code":"158","type":"RC"},{"code":"D0604","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":34997.23,"maximum":34997.23,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":34997.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":34997.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":34997.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":34997.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":34997.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":34997.23,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":34997.23,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 47.75 ","code_information":[{"code":"128","type":"RC"},{"code":"C0601","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20001.87,"maximum":20001.87,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":20001.87,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 26.15 & M < 35.05 ","code_information":[{"code":"118","type":"RC"},{"code":"D0303","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27555.85,"maximum":27555.85,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":27555.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":27555.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":27555.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":27555.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":27555.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":27555.85,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":27555.85,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 31.25 & M < 4 ","code_information":[{"code":"138","type":"RC"},{"code":"A0503","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24867.62,"maximum":24867.62,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24867.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24867.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24867.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24867.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24867.62,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24867.62,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":24867.62,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M > 30.75 & M < 37.65 ","code_information":[{"code":"138","type":"RC"},{"code":"D1202","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23037.94,"maximum":23037.94,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":23037.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":23037.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":23037.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":23037.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":23037.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":23037.94,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":23037.94,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M < 24.15 ","code_information":[{"code":"148","type":"RC"},{"code":"B0904","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":43059.91,"maximum":43059.91,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":43059.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":43059.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":43059.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":43059.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":43059.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":43059.91,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":43059.91,"methodology":"fee schedule"}]}]},{"description":"PAIN SYNDROME: M < 26.75 ","code_information":[{"code":"158","type":"RC"},{"code":"B1603","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":38095.63,"maximum":38095.63,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":38095.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":38095.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":38095.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":38095.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":38095.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":38095.63,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":38095.63,"methodology":"fee schedule"}]}]},{"description":"PAIN SYNDROME; M > 37.15 ","code_information":[{"code":"128","type":"RC"},{"code":"D1601","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":17673.54,"maximum":17673.54,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17673.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17673.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17673.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17673.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17673.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17673.54,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17673.54,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 39.05 & M < 49.25 ","code_information":[{"code":"118","type":"RC"},{"code":"B1502","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32491.97,"maximum":32491.97,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":32491.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":32491.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":32491.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":32491.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":32491.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":32491.97,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":32491.97,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 22.05 & ","code_information":[{"code":"128","type":"RC"},{"code":"C0805","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":33256.02,"maximum":33256.02,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":33256.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":33256.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":33256.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":33256.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":33256.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":33256.02,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":33256.02,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 49.55 ","code_information":[{"code":"118","type":"RC"},{"code":"A0801","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":16678.27,"maximum":16678.27,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16678.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16678.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16678.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16678.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16678.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16678.27,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":16678.27,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M < 26.15 ","code_information":[{"code":"138","type":"RC"},{"code":"D1303","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26910.43,"maximum":26910.43,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":26910.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":26910.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":26910.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":26910.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":26910.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":26910.43,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":26910.43,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M=12-35 ","code_information":[{"code":"118","type":"RC"},{"code":"B1304","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":43059.91,"maximum":43059.91,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":43059.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":43059.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":43059.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":43059.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":43059.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":43059.91,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":43059.91,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, LOWER EXTREMITY; M < 36.25 ","code_information":[{"code":"138","type":"RC"},{"code":"D1003","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27302.51,"maximum":27302.51,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":27302.51,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M < 36.35 ","code_information":[{"code":"158","type":"RC"},{"code":"A1102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25468.80,"maximum":25468.80,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":25468.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":25468.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":25468.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":25468.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":25468.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":25468.80,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25468.80,"methodology":"fee schedule"}]}]},{"description":"BURNS; M=12-45 ","code_information":[{"code":"128","type":"RC"},{"code":"A2102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":30240.05,"maximum":30240.05,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":30240.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":30240.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":30240.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":30240.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":30240.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":30240.05,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":30240.05,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M > 31.15 & M < 38.55 ","code_information":[{"code":"138","type":"RC"},{"code":"D1403","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25790.50,"maximum":25790.50,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":25790.50,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25790.50,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 28.15 & M < 34.15 ","code_information":[{"code":"128","type":"RC"},{"code":"B0703","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":38304.74,"maximum":38304.74,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":38304.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":38304.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":38304.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":38304.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":38304.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":38304.74,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":38304.74,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 42.15 ","code_information":[{"code":"138","type":"RC"},{"code":"C0701","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19507.25,"maximum":19507.25,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19507.25,"methodology":"fee schedule"}]}]},{"description":"GUILLIAN BARRE; M > 18.05 & M < 35.95 ","code_information":[{"code":"158","type":"RC"},{"code":"B1902","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":33467.13,"maximum":33467.13,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":33467.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":33467.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":33467.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":33467.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":33467.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":33467.13,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":33467.13,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA W BRAIN OR SPINAL CORD INJURY; M > ","code_information":[{"code":"148","type":"RC"},{"code":"A1802","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20084.30,"maximum":20084.30,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20084.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20084.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20084.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20084.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20084.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20084.30,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":20084.30,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CORD IN ","code_information":[{"code":"148","type":"RC"},{"code":"A1803","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25804.58,"maximum":25804.58,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":25804.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":25804.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":25804.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":25804.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":25804.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":25804.58,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25804.58,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 38.75 & M < 49.15 ","code_information":[{"code":"128","type":"RC"},{"code":"D2002","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22080.87,"maximum":22080.87,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":22080.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":22080.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":22080.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":22080.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":22080.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":22080.87,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":22080.87,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M < 25.85 ","code_information":[{"code":"128","type":"RC"},{"code":"B0604","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":50073.03,"maximum":50073.03,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":50073.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":50073.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":50073.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":50073.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":50073.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":50073.03,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":50073.03,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 47.75 ","code_information":[{"code":"128","type":"RC"},{"code":"A0601","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":16841.14,"maximum":16841.14,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16841.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16841.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16841.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16841.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16841.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16841.14,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":16841.14,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 35.05 & M < 41.05 ","code_information":[{"code":"118","type":"RC"},{"code":"C0302","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24931.96,"maximum":24931.96,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24931.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24931.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24931.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24931.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24931.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24931.96,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":24931.96,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 31.25 & M < 4 ","code_information":[{"code":"128","type":"RC"},{"code":"C0503","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28563.18,"maximum":28563.18,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":28563.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":28563.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":28563.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":28563.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":28563.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":28563.18,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":28563.18,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 51.35 ","code_information":[{"code":"148","type":"RC"},{"code":"C0501","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19863.13,"maximum":19863.13,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":19863.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":19863.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":19863.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":19863.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":19863.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":19863.13,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19863.13,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M=39-47 ","code_information":[{"code":"118","type":"RC"},{"code":"D1204","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31297.65,"maximum":31297.65,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":31297.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":31297.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":31297.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":31297.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":31297.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":31297.65,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":31297.65,"methodology":"fee schedule"}]}]},{"description":"PAIN SYNDROME; M > 26.75 & M < 37.15 ","code_information":[{"code":"138","type":"RC"},{"code":"C1602","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22406.59,"maximum":22406.59,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":22406.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":22406.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":22406.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":22406.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":22406.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":22406.59,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":22406.59,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 29.15 & M < 39.05 ","code_information":[{"code":"118","type":"RC"},{"code":"D1503","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28187.19,"maximum":28187.19,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":28187.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":28187.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":28187.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":28187.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":28187.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":28187.19,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":28187.19,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 49.25 ","code_information":[{"code":"128","type":"RC"},{"code":"D1501","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19551.48,"maximum":19551.48,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":19551.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":19551.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":19551.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":19551.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":19551.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":19551.48,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19551.48,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 22.05 & ","code_information":[{"code":"148","type":"RC"},{"code":"A0805","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28279.68,"maximum":28279.68,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":28279.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":28279.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":28279.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":28279.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":28279.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":28279.68,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":28279.68,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M < 26.15 ","code_information":[{"code":"128","type":"RC"},{"code":"D1303","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26910.43,"maximum":26910.43,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":26910.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":26910.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":26910.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":26910.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":26910.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":26910.43,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":26910.43,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 30.05 & M < 34.25 ","code_information":[{"code":"118","type":"RC"},{"code":"B0106","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":58437.30,"maximum":58437.30,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":58437.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":58437.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":58437.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":58437.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":58437.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":58437.30,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":58437.30,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 44.45 & M < 51.05 & C < 18.5 ","code_information":[{"code":"128","type":"RC"},{"code":"B0103","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32194.40,"maximum":32194.40,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":32194.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":32194.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":32194.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":32194.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":32194.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":32194.40,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":32194.40,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 51.05 ","code_information":[{"code":"138","type":"RC"},{"code":"D0101","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":15600.57,"maximum":15600.57,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":15600.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":15600.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":15600.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":15600.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":15600.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":15600.57,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":15600.57,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 44.25 & M < 53.35 & C ","code_information":[{"code":"138","type":"RC"},{"code":"D0202","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20058.16,"maximum":20058.16,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20058.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20058.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20058.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20058.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20058.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20058.16,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":20058.16,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M < 16.05 & A > 63.5 ","code_information":[{"code":"128","type":"RC"},{"code":"A0404","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":48066.41,"maximum":48066.41,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":48066.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":48066.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":48066.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":48066.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":48066.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":48066.41,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":48066.41,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M > 48.45 ","code_information":[{"code":"158","type":"RC"},{"code":"D0401","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20932.79,"maximum":20932.79,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20932.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20932.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20932.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20932.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20932.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20932.79,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":20932.79,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 44.45 & M < 51.05 & C < 18.5 ","code_information":[{"code":"158","type":"RC"},{"code":"B0103","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32194.40,"maximum":32194.40,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":32194.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":32194.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":32194.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":32194.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":32194.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":32194.40,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":32194.40,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 28.75 & M < 40.65 ","code_information":[{"code":"128","type":"RC"},{"code":"A0205","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":37363.76,"maximum":37363.76,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":37363.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":37363.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":37363.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":37363.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":37363.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":37363.76,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":37363.76,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 44.25 & C < 23.5 ","code_information":[{"code":"128","type":"RC"},{"code":"D0203","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24980.22,"maximum":24980.22,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24980.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24980.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24980.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24980.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24980.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24980.22,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":24980.22,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M < 16.05 & A < 63.5 ","code_information":[{"code":"118","type":"RC"},{"code":"C0405","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":43335.37,"maximum":43335.37,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":43335.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":43335.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":43335.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":43335.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":43335.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":43335.37,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":43335.37,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M > 30.35 & M < 48.4 ","code_information":[{"code":"118","type":"RC"},{"code":"C0402","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27811.20,"maximum":27811.20,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":27811.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":27811.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":27811.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":27811.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":27811.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":27811.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":27811.20,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 35.05 & M < 41.05 ","code_information":[{"code":"148","type":"RC"},{"code":"B0302","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31160.93,"maximum":31160.93,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":31160.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":31160.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":31160.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":31160.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":31160.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":31160.93,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":31160.93,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 29.25 & M < 3 ","code_information":[{"code":"128","type":"RC"},{"code":"B0504","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":43645.00,"maximum":43645.00,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":43645.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":43645.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":43645.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":43645.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":43645.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":43645.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":43645.00,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M < 30.75 ","code_information":[{"code":"128","type":"RC"},{"code":"A1203","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27284.41,"maximum":27284.41,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":27284.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":27284.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":27284.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":27284.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":27284.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":27284.41,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":27284.41,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M > 30.75 & M < 37.65 ","code_information":[{"code":"158","type":"RC"},{"code":"C1202","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24570.04,"maximum":24570.04,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24570.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24570.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24570.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24570.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24570.04,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24570.04,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":24570.04,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M > 37.65 ","code_information":[{"code":"148","type":"RC"},{"code":"C1201","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20295.42,"maximum":20295.42,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20295.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20295.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20295.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20295.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20295.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20295.42,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":20295.42,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M > 24.15 & M < 34.35 ","code_information":[{"code":"148","type":"RC"},{"code":"B0903","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":35936.20,"maximum":35936.20,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":35936.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":35936.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":35936.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":35936.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":35936.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":35936.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":35936.20,"methodology":"fee schedule"}]}]},{"description":"PAIN SYNDROME: M < 26.75 ","code_information":[{"code":"158","type":"RC"},{"code":"D1603","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25575.37,"maximum":25575.37,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":25575.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":25575.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":25575.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":25575.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":25575.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":25575.37,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25575.37,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 29.15 & M < 39.05 ","code_information":[{"code":"148","type":"RC"},{"code":"C1503","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":29970.63,"maximum":29970.63,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":29970.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":29970.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":29970.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":29970.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":29970.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":29970.63,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":29970.63,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 37.05 & ","code_information":[{"code":"118","type":"RC"},{"code":"B0802","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27712.68,"maximum":27712.68,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":27712.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":27712.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":27712.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":27712.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":27712.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":27712.68,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":27712.68,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M > 26.15 & M < 36.35 ","code_information":[{"code":"138","type":"RC"},{"code":"C1302","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24781.16,"maximum":24781.16,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24781.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24781.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24781.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24781.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24781.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24781.16,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":24781.16,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M > 36.35 ","code_information":[{"code":"138","type":"RC"},{"code":"C1301","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18127.95,"maximum":18127.95,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":18127.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":18127.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":18127.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":18127.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":18127.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":18127.95,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":18127.95,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 34.25 & M < 38.85 ","code_information":[{"code":"148","type":"RC"},{"code":"B0105","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":51377.93,"maximum":51377.93,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":51377.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":51377.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":51377.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":51377.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":51377.93,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":51377.93,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":51377.93,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 40.65 & M < 44.25 ","code_information":[{"code":"138","type":"RC"},{"code":"D0204","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":30981.98,"maximum":30981.98,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":30981.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":30981.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":30981.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":30981.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":30981.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":30981.98,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":30981.98,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M < 16.05 & A < 63.5 ","code_information":[{"code":"158","type":"RC"},{"code":"C0405","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":43335.37,"maximum":43335.37,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":43335.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":43335.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":43335.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":43335.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":43335.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":43335.37,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":43335.37,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M > 48.45 ","code_information":[{"code":"138","type":"RC"},{"code":"A0401","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19020.67,"maximum":19020.67,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":19020.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":19020.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":19020.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":19020.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":19020.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":19020.67,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19020.67,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, LOWER EXTREMITY; M < 36.25 ","code_information":[{"code":"118","type":"RC"},{"code":"D1003","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27302.51,"maximum":27302.51,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":27302.51,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M < 36.35 ","code_information":[{"code":"118","type":"RC"},{"code":"B1102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32337.15,"maximum":32337.15,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":32337.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":32337.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":32337.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":32337.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":32337.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":32337.15,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":32337.15,"methodology":"fee schedule"}]}]},{"description":"BURNS; M=12-45 ","code_information":[{"code":"158","type":"RC"},{"code":"B2102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":46598.64,"maximum":46598.64,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":46598.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":46598.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":46598.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":46598.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":46598.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":46598.64,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":46598.64,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M > 31.15 & M < 38.55 ","code_information":[{"code":"128","type":"RC"},{"code":"C1403","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27738.82,"maximum":27738.82,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":27738.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":27738.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":27738.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":27738.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":27738.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":27738.82,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":27738.82,"methodology":"fee schedule"}]}]},{"description":"EXPIRED, ORTHOPEDIC, LENGTH OF STAY IS 14 DAYS OR ","code_information":[{"code":"118","type":"RC"},{"code":"A5102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":36042.77,"maximum":36042.77,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":36042.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":36042.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":36042.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":36042.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":36042.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":36042.77,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36042.77,"methodology":"fee schedule"}]}]},{"description":"GUILLIAN BARRE; M < 18.05 ","code_information":[{"code":"158","type":"RC"},{"code":"D1903","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":36223.72,"maximum":36223.72,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":36223.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":36223.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":36223.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":36223.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":36223.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":36223.72,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36223.72,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA NO BRAIN OR SPINAL CORD INJURY; M ","code_information":[{"code":"158","type":"RC"},{"code":"B1703","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":39690.07,"maximum":39690.07,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":39690.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":39690.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":39690.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":39690.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":39690.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":39690.07,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":39690.07,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA W BRAIN OR SPINAL CORD INJURY; M > ","code_information":[{"code":"148","type":"RC"},{"code":"B1802","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28601.38,"maximum":28601.38,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":28601.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":28601.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":28601.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":28601.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":28601.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":28601.38,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":28601.38,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CODE IN ","code_information":[{"code":"158","type":"RC"},{"code":"A1804","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28217.35,"maximum":28217.35,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":28217.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":28217.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":28217.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":28217.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":28217.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":28217.35,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":28217.35,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M < 27.85 ","code_information":[{"code":"158","type":"RC"},{"code":"D2004","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31615.33,"maximum":31615.33,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":31615.33,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 37.35 & M < 47.75 ","code_information":[{"code":"158","type":"RC"},{"code":"A0602","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21359.05,"maximum":21359.05,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":21359.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":21359.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":21359.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":21359.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":21359.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":21359.05,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":21359.05,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M < 26.15 ","code_information":[{"code":"138","type":"RC"},{"code":"C0304","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":34780.08,"maximum":34780.08,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":34780.08,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":34780.08,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":34780.08,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":34780.08,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":34780.08,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":34780.08,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":34780.08,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 31.25 & M < 4 ","code_information":[{"code":"128","type":"RC"},{"code":"B0503","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":36716.33,"maximum":36716.33,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":36716.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":36716.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":36716.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":36716.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":36716.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":36716.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36716.33,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M < 30.75 ","code_information":[{"code":"118","type":"RC"},{"code":"C1203","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31830.47,"maximum":31830.47,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":31830.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":31830.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":31830.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":31830.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":31830.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":31830.47,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":31830.47,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M > 37.65 ","code_information":[{"code":"158","type":"RC"},{"code":"A1201","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":17396.07,"maximum":17396.07,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17396.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17396.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17396.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17396.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17396.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17396.07,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17396.07,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M > 44.75 ","code_information":[{"code":"158","type":"RC"},{"code":"B0901","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24161.88,"maximum":24161.88,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24161.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24161.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24161.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24161.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24161.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24161.88,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":24161.88,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M < 29.15 ","code_information":[{"code":"118","type":"RC"},{"code":"C1504","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":37116.45,"maximum":37116.45,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":37116.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":37116.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":37116.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":37116.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":37116.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":37116.45,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":37116.45,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 49.25 ","code_information":[{"code":"128","type":"RC"},{"code":"A1501","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18288.80,"maximum":18288.80,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":18288.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":18288.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":18288.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":18288.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":18288.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":18288.80,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":18288.80,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXT JOINT; M > 28.65 & M < 37 ","code_information":[{"code":"128","type":"RC"},{"code":"B0804","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":34556.90,"maximum":34556.90,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":34556.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":34556.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":34556.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":34556.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":34556.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":34556.90,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":34556.90,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 49.55 ","code_information":[{"code":"158","type":"RC"},{"code":"D0801","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":17882.65,"maximum":17882.65,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17882.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17882.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17882.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17882.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17882.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17882.65,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17882.65,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 30.05 & M < 34.25 ","code_information":[{"code":"148","type":"RC"},{"code":"D0106","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":46313.13,"maximum":46313.13,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":46313.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":46313.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":46313.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":46313.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":46313.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":46313.13,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":46313.13,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 44.45 & M < 51.05 & C > 18.5 ","code_information":[{"code":"118","type":"RC"},{"code":"B0102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24978.20,"maximum":24978.20,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24978.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24978.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24978.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24978.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24978.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24978.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":24978.20,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M < 16.05 & A < 63.5 ","code_information":[{"code":"148","type":"RC"},{"code":"D0405","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":42066.65,"maximum":42066.65,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":42066.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":42066.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":42066.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":42066.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":42066.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":42066.65,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":42066.65,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 44.45 & M < 51.05 & C > 18.5 ","code_information":[{"code":"128","type":"RC"},{"code":"C0102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21662.66,"maximum":21662.66,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":21662.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":21662.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":21662.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":21662.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":21662.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":21662.66,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":21662.66,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 40.65 & M < 44.25 ","code_information":[{"code":"138","type":"RC"},{"code":"A0204","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":29170.39,"maximum":29170.39,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":29170.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":29170.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":29170.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":29170.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":29170.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":29170.39,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":29170.39,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M < 16.05 & A < 63.5 ","code_information":[{"code":"128","type":"RC"},{"code":"B0405","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":48729.92,"maximum":48729.92,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":48729.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":48729.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":48729.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":48729.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":48729.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":48729.92,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":48729.92,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M < 16.05 & A > 63.5 ","code_information":[{"code":"138","type":"RC"},{"code":"D0404","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":52897.98,"maximum":52897.98,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":52897.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":52897.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":52897.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":52897.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":52897.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":52897.98,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":52897.98,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, LOWER EXTREMITY; M > 36.25 & M < 47.65 ","code_information":[{"code":"128","type":"RC"},{"code":"C1002","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25509.01,"maximum":25509.01,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":25509.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":25509.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":25509.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":25509.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":25509.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":25509.01,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25509.01,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, LOWER EXTREMITY; M=39-45 ","code_information":[{"code":"148","type":"RC"},{"code":"A1004","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31315.75,"maximum":31315.75,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":31315.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":31315.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":31315.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":31315.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":31315.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":31315.75,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":31315.75,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M=12-37 ","code_information":[{"code":"148","type":"RC"},{"code":"D1103","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32415.57,"maximum":32415.57,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":32415.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":32415.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":32415.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":32415.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":32415.57,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":32415.57,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":32415.57,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M > 31.15 & M < 38.55 ","code_information":[{"code":"158","type":"RC"},{"code":"A1403","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23731.61,"maximum":23731.61,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":23731.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":23731.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":23731.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":23731.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":23731.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":23731.61,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":23731.61,"methodology":"fee schedule"}]}]},{"description":"EXPIRED, NOT ORTHOPEDIC, LENGTH OF STAY IS 16 DAYS ","code_information":[{"code":"148","type":"RC"},{"code":"A5104","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":47921.64,"maximum":47921.64,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":47921.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":47921.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":47921.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":47921.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":47921.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":47921.64,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":47921.64,"methodology":"fee schedule"}]}]},{"description":"GUILLIAN BARRE; M < 18.05 ","code_information":[{"code":"138","type":"RC"},{"code":"B1903","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":50495.26,"maximum":50495.26,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":50495.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":50495.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":50495.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":50495.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":50495.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":50495.26,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":50495.26,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA NO BRAIN OR SPINAL CORD INJURY; M ","code_information":[{"code":"138","type":"RC"},{"code":"B1702","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":33400.78,"maximum":33400.78,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":33400.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":33400.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":33400.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":33400.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":33400.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":33400.78,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":33400.78,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA W BRAIN OR SPINAL CORD INJURY; M > ","code_information":[{"code":"138","type":"RC"},{"code":"A1802","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20084.30,"maximum":20084.30,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20084.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20084.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20084.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20084.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20084.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20084.30,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":20084.30,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CORD IN ","code_information":[{"code":"148","type":"RC"},{"code":"B1803","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":36746.49,"maximum":36746.49,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":36746.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":36746.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":36746.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":36746.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":36746.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":36746.49,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36746.49,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA,NO BRAIN OR SPINAL CORD INJU ","code_information":[{"code":"138","type":"RC"},{"code":"C1704","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":34918.82,"maximum":34918.82,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":34918.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":34918.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":34918.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":34918.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":34918.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":34918.82,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":34918.82,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 38.75 & M < 49.15 ","code_information":[{"code":"148","type":"RC"},{"code":"C2002","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23637.11,"maximum":23637.11,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":23637.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":23637.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":23637.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":23637.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":23637.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":23637.11,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":23637.11,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M < 25.85 ","code_information":[{"code":"118","type":"RC"},{"code":"D0604","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":34997.23,"maximum":34997.23,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":34997.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":34997.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":34997.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":34997.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":34997.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":34997.23,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":34997.23,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 47.75 ","code_information":[{"code":"128","type":"RC"},{"code":"D0601","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":18672.83,"maximum":18672.83,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":18672.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":18672.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":18672.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":18672.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":18672.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":18672.83,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":18672.83,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 26.15 & M < 35.05 ","code_information":[{"code":"128","type":"RC"},{"code":"B0303","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":37494.45,"maximum":37494.45,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":37494.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":37494.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":37494.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":37494.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":37494.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":37494.45,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":37494.45,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 31.25 & M < 4 ","code_information":[{"code":"148","type":"RC"},{"code":"D0503","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26984.83,"maximum":26984.83,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":26984.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":26984.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":26984.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":26984.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":26984.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":26984.83,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":26984.83,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M > 30.75 & M < 37.65 ","code_information":[{"code":"128","type":"RC"},{"code":"A1202","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21061.47,"maximum":21061.47,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":21061.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":21061.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":21061.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":21061.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":21061.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":21061.47,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":21061.47,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M < 24.15 ","code_information":[{"code":"158","type":"RC"},{"code":"D0904","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32146.14,"maximum":32146.14,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":32146.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":32146.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":32146.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":32146.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":32146.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":32146.14,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":32146.14,"methodology":"fee schedule"}]}]},{"description":"OTHER ORTHOPEDIC; M > 34.35 & M < 44.75 ","code_information":[{"code":"158","type":"RC"},{"code":"D0902","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":22464.90,"maximum":22464.90,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":22464.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":22464.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":22464.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":22464.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":22464.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":22464.90,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":22464.90,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, LOWER EXTREMITY; M < 36.25 ","code_information":[{"code":"148","type":"RC"},{"code":"D1003","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27302.51,"maximum":27302.51,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":27302.51,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":27302.51,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M < 36.35 ","code_information":[{"code":"138","type":"RC"},{"code":"C1102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25993.58,"maximum":25993.58,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":25993.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":25993.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":25993.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":25993.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":25993.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":25993.58,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25993.58,"methodology":"fee schedule"}]}]},{"description":"BURNS; M=12-45 ","code_information":[{"code":"148","type":"RC"},{"code":"C2102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":35409.41,"maximum":35409.41,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":35409.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":35409.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":35409.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":35409.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":35409.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":35409.41,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":35409.41,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M > 31.15 & M < 38.55 ","code_information":[{"code":"158","type":"RC"},{"code":"C1403","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27738.82,"maximum":27738.82,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":27738.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":27738.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":27738.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":27738.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":27738.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":27738.82,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":27738.82,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M > 48.85 ","code_information":[{"code":"128","type":"RC"},{"code":"C1401","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":17874.61,"maximum":17874.61,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17874.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17874.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17874.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17874.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17874.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17874.61,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17874.61,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 28.15 & M < 34.15 ","code_information":[{"code":"138","type":"RC"},{"code":"A0703","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25933.26,"maximum":25933.26,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":25933.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":25933.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":25933.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":25933.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":25933.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":25933.26,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25933.26,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 42.15 ","code_information":[{"code":"148","type":"RC"},{"code":"A0701","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":17074.37,"maximum":17074.37,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17074.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17074.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17074.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17074.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17074.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17074.37,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17074.37,"methodology":"fee schedule"}]}]},{"description":"GUILLIAN BARRE; M > 35.95 ","code_information":[{"code":"128","type":"RC"},{"code":"B1901","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20914.70,"maximum":20914.70,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20914.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20914.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20914.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20914.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20914.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20914.70,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":20914.70,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA NO BRAIN OR SPINAL CORD INJURY; M ","code_information":[{"code":"148","type":"RC"},{"code":"D1703","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":28573.23,"maximum":28573.23,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":28573.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":28573.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":28573.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":28573.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":28573.23,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":28573.23,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":28573.23,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA WITH BRAIN OR SPINAL CORD IN ","code_information":[{"code":"128","type":"RC"},{"code":"C1803","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":29315.16,"maximum":29315.16,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":29315.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":29315.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":29315.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":29315.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":29315.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":29315.16,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":29315.16,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M < 27.85 ","code_information":[{"code":"118","type":"RC"},{"code":"B2004","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":42370.26,"maximum":42370.26,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":42370.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":42370.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":42370.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":42370.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":42370.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":42370.26,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":42370.26,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M > 38.75 & M < 49.15 ","code_information":[{"code":"138","type":"RC"},{"code":"A2002","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20098.38,"maximum":20098.38,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20098.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20098.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20098.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20098.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20098.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20098.38,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":20098.38,"methodology":"fee schedule"}]}]},{"description":"MISCELLANEOUS; M=12-32 AND A tm81 ","code_information":[{"code":"118","type":"RC"},{"code":"A2005","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":30332.54,"maximum":30332.54,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":30332.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":30332.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":30332.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":30332.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":30332.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":30332.54,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":30332.54,"methodology":"fee schedule"}]}]},{"description":"NEUROLOGICAL; M > 47.75 ","code_information":[{"code":"138","type":"RC"},{"code":"C0601","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":20001.87,"maximum":20001.87,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20001.87,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":20001.87,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC BRAIN INJURY; M > 41.05 ","code_information":[{"code":"148","type":"RC"},{"code":"A0301","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":16694.36,"maximum":16694.36,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16694.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16694.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16694.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16694.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16694.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16694.36,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":16694.36,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 29.25 & M < 3 ","code_information":[{"code":"148","type":"RC"},{"code":"B0504","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":43645.00,"maximum":43645.00,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":43645.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":43645.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":43645.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":43645.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":43645.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":43645.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":43645.00,"methodology":"fee schedule"}]}]},{"description":"NONTRAUMATIC SPINAL CORD INJURY; M > 51.35 ","code_information":[{"code":"158","type":"RC"},{"code":"B0501","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":25533.14,"maximum":25533.14,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":25533.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":25533.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":25533.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":25533.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":25533.14,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":25533.14,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25533.14,"methodology":"fee schedule"}]}]},{"description":"OSTEOARTHRITIS; M=39-47 ","code_information":[{"code":"128","type":"RC"},{"code":"C1204","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":33380.68,"maximum":33380.68,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":33380.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":33380.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":33380.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":33380.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":33380.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":33380.68,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":33380.68,"methodology":"fee schedule"}]}]},{"description":"PAIN SYNDROME: M < 26.75 ","code_information":[{"code":"118","type":"RC"},{"code":"A1603","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23675.31,"maximum":23675.31,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":23675.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":23675.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":23675.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":23675.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":23675.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":23675.31,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":23675.31,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M < 29.15 ","code_information":[{"code":"158","type":"RC"},{"code":"A1504","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32652.82,"maximum":32652.82,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":32652.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":32652.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":32652.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":32652.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":32652.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":32652.82,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":32652.82,"methodology":"fee schedule"}]}]},{"description":"PULMONARY; M > 39.05 & M < 49.25 ","code_information":[{"code":"138","type":"RC"},{"code":"C1502","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26371.58,"maximum":26371.58,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":26371.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":26371.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":26371.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":26371.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":26371.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":26371.58,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":26371.58,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXT JOINT; M > 28.65 & M < 37 ","code_information":[{"code":"148","type":"RC"},{"code":"A0804","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":23578.80,"maximum":23578.80,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":23578.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":23578.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":23578.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":23578.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":23578.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":23578.80,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":23578.80,"methodology":"fee schedule"}]}]},{"description":"REPLACEMENT OF LOWER EXTREMITY JOINT; M > 37.05 & ","code_information":[{"code":"148","type":"RC"},{"code":"B0802","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":27712.68,"maximum":27712.68,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":27712.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":27712.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":27712.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":27712.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":27712.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":27712.68,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":27712.68,"methodology":"fee schedule"}]}]},{"description":"RHEUMATOID, OTHER ARTHRITIS; M=12-35 ","code_information":[{"code":"128","type":"RC"},{"code":"A1304","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31615.33,"maximum":31615.33,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":31615.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":31615.33,"methodology":"fee schedule"}]}]},{"description":"STROKE; M > 38.85 & M < 44.45 ","code_information":[{"code":"158","type":"RC"},{"code":"A0104","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31032.25,"maximum":31032.25,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":31032.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":31032.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":31032.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":31032.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":31032.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":31032.25,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":31032.25,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 28.75 & M < 40.65 ","code_information":[{"code":"148","type":"RC"},{"code":"B0205","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":53050.79,"maximum":53050.79,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":53050.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":53050.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":53050.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":53050.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":53050.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":53050.79,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":53050.79,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC BRAIN INJURY; M > 44.25 & M < 53.35 & C ","code_information":[{"code":"138","type":"RC"},{"code":"B0202","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":26813.92,"maximum":26813.92,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":26813.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":26813.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":26813.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":26813.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":26813.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":26813.92,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":26813.92,"methodology":"fee schedule"}]}]},{"description":"TRAUMATIC SPINAL CORD INJURY; M > 30.35 & M < 48.4 ","code_information":[{"code":"138","type":"RC"},{"code":"A0402","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24531.84,"maximum":24531.84,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24531.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24531.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24531.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24531.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24531.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24531.84,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":24531.84,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, LOWER EXTREMITY; M > 47.65 ","code_information":[{"code":"158","type":"RC"},{"code":"B1001","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":24348.87,"maximum":24348.87,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24348.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24348.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24348.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24348.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24348.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24348.87,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":24348.87,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M < 36.35 ","code_information":[{"code":"128","type":"RC"},{"code":"B1102","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":32337.15,"maximum":32337.15,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":32337.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":32337.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":32337.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":32337.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":32337.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":32337.15,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":32337.15,"methodology":"fee schedule"}]}]},{"description":"AMPUTATION, NON-LOWER EXTREMITY; M=12-37 ","code_information":[{"code":"158","type":"RC"},{"code":"B1103","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":40325.43,"maximum":40325.43,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":40325.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":40325.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":40325.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":40325.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":40325.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":40325.43,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":40325.43,"methodology":"fee schedule"}]}]},{"description":"CARDIAC; M < 31.15 ","code_information":[{"code":"148","type":"RC"},{"code":"D1404","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":31601.26,"maximum":31601.26,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":31601.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":31601.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":31601.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":31601.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":31601.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":31601.26,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":31601.26,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 28.15 & M < 34.15 ","code_information":[{"code":"118","type":"RC"},{"code":"B0703","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":38304.74,"maximum":38304.74,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":38304.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":38304.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":38304.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":38304.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":38304.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":38304.74,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":38304.74,"methodology":"fee schedule"}]}]},{"description":"FRACTURE OF LOWER EXTREMITY; M > 42.15 ","code_information":[{"code":"118","type":"RC"},{"code":"C0701","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19507.25,"maximum":19507.25,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":19507.25,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19507.25,"methodology":"fee schedule"}]}]},{"description":"MAJ MULT TRAUMA NO BRAIN OR SPINAL CORD INJURY; M ","code_information":[{"code":"138","type":"RC"},{"code":"A1702","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":21815.46,"maximum":21815.46,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":21815.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":21815.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":21815.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":21815.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":21815.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":21815.46,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":21815.46,"methodology":"fee schedule"}]}]},{"description":"MAJOR MULTIPLE TRAUMA NO BRAIN OR SPINAL CORD INJU ","code_information":[{"code":"128","type":"RC"},{"code":"D1701","type":"HIPPS"}],"standard_charges":[{"setting":"inpatient","minimum":19354.44,"maximum":19354.44,"payers_information":[{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":19354.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":19354.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":19354.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":19354.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":19354.44,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":19354.44,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19354.44,"methodology":"fee schedule"}]}]},{"description":"Injection, gadoterate meglumine, 0.1 ml ","code_information":[{"code":"636","type":"RC"},{"code":"A9575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":0.20,"maximum":0.36,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":0.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":0.20,"methodology":"fee schedule"}]}]},{"description":"Injection, gadoxetate disodium, 1 ml ","code_information":[{"code":"343","type":"RC"},{"code":"A9581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":24.30,"maximum":44.19,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":44.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":24.30,"methodology":"fee schedule"}]}]},{"description":"Injection, galsulfase, 1 mg ","code_information":[{"code":"344","type":"RC"},{"code":"J1458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":784.86,"maximum":1427.01,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1427.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":784.86,"methodology":"fee schedule"}]}]},{"description":"Injection, ganciclovir sodium (exela), not therapeutically equivalent to j1570, 500 mg ","code_information":[{"code":"343","type":"RC"},{"code":"J1574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":99.00,"maximum":180.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":180.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":99.00,"methodology":"fee schedule"}]}]},{"description":"Liver allotransplantation, orthotopic, partial or whole, from cadaver or living donor, any age ","code_information":[{"code":"47135","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Liver disease, 10 biochemical assays (a2-macroglobulin, haptoglobin, apolipoprotein A1, bilirubin, GGT, ALT, AST, triglycerides, cholesterol, fasting glucose) and biometric and demographic data, utili ","code_information":[{"code":"0166U","type":"CPT"},{"code":"309","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":503.40,"maximum":503.40,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":503.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":503.40,"methodology":"fee schedule"}]}]},{"description":"Liver disease, analysis of 3 biomarkers (hyaluronic acid ºHA», procollagen III amino terminal peptide ºPIIINP», tissue inhibitor of metalloproteinase 1 ºTIMP-1»), using immunoassays, utilizing serum, ","code_information":[{"code":"304","type":"RC"},{"code":"81517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":176.19,"maximum":176.19,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":176.19,"methodology":"fee schedule"}]}]},{"description":"Liver imaging; static only ","code_information":[{"code":"341","type":"RC"},{"code":"78201","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":831.98,"maximum":1101.15,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1101.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":831.98,"methodology":"fee schedule"}]}]},{"description":"Liver imaging; with vascular flow ","code_information":[{"code":"340","type":"RC"},{"code":"78202","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":831.98,"maximum":1101.15,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1101.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":831.98,"methodology":"fee schedule"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC ","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":3928.00,"maximum":4693.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":4693.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":3928.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."}]}]},{"description":"Longevity and mortality risk, mRNA, gene expression profiling by RNA sequencing of 18 genes, whole blood, algorithm reported as predictive risk score ","code_information":[{"code":"0294U","type":"CPT"},{"code":"300","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":760.00,"maximum":760.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":760.00,"methodology":"fee schedule"}]}]},{"description":"Low intensity ultrasound stimulation to aid bone healing, noninvasive (nonoperative) ","code_information":[{"code":"20979","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1813.00,"maximum":2617.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2617.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1813.00,"methodology":"case rate"}]}]},{"description":"Low intensity ultrasound stimulation to aid bone healing, noninvasive (nonoperative) ","code_information":[{"code":"20979","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1813.00,"maximum":2617.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2617.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1813.00,"methodology":"case rate"}]}]},{"description":"Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml ","code_information":[{"code":"344","type":"RC"},{"code":"Q9965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3.12,"maximum":5.67,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":3.12,"methodology":"fee schedule"}]}]},{"description":"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml ","code_information":[{"code":"891","type":"RC"},{"code":"Q9966","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":0.58,"maximum":1.05,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":0.58,"methodology":"fee schedule"}]}]},{"description":"Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml ","code_information":[{"code":"892","type":"RC"},{"code":"Q9966","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":0.58,"maximum":1.05,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":0.58,"methodology":"fee schedule"}]}]},{"description":"Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml ","code_information":[{"code":"343","type":"RC"},{"code":"Q9967","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":0.23,"maximum":0.42,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":0.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":0.23,"methodology":"fee schedule"}]}]},{"description":"Lower esophageal myotomy, transoral (ie, peroral endoscopic myotomy ºPOEM») ","code_information":[{"code":"360","type":"RC"},{"code":"43497","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC ","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":3928.00,"maximum":4693.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":4693.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":3928.00,"methodology":"per diem","additional_payer_notes":"Days 5+. "}]}]},{"description":"Lung transplant, double (bilateral sequential or en bloc); with cardiopulmonary bypass ","code_information":[{"code":"32854","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Lung transplant, double (bilateral sequential or en bloc); without cardiopulmonary bypass ","code_information":[{"code":"32853","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Lung transplant, double (bilateral sequential or en bloc); without cardiopulmonary bypass ","code_information":[{"code":"32853","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Lung transplant, single; with cardiopulmonary bypass ","code_information":[{"code":"32852","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Lung transplant, single; with cardiopulmonary bypass ","code_information":[{"code":"32852","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Lung transplant, single; without cardiopulmonary bypass ","code_information":[{"code":"32851","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Luteinizing releasing factor (LRH) ","code_information":[{"code":"301","type":"RC"},{"code":"83727","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.19,"maximum":17.19,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":17.19,"methodology":"fee schedule"}]}]},{"description":"Luteinizing releasing factor (LRH) ","code_information":[{"code":"306","type":"RC"},{"code":"83727","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.19,"maximum":17.19,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":17.19,"methodology":"fee schedule"}]}]},{"description":"Luteinizing releasing factor (LRH) ","code_information":[{"code":"83727","type":"CPT"},{"code":"923","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":17.19,"maximum":17.19,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":17.19,"methodology":"fee schedule"}]}]},{"description":"Lutetium lu 177, dotatate, therapeutic, 1 millicurie ","code_information":[{"code":"344","type":"RC"},{"code":"A9513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":487.64,"maximum":886.62,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":886.62,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":487.64,"methodology":"fee schedule"}]}]},{"description":"Lymphangiography, extremity only, bilateral, radiological supervision and interpretation ","code_information":[{"code":"323","type":"RC"},{"code":"75803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2390.44,"maximum":3163.82,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3163.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":2390.44,"methodology":"fee schedule"}]}]},{"description":"Lymphangiography, extremity only, bilateral, radiological supervision and interpretation ","code_information":[{"code":"400","type":"RC"},{"code":"75803","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2390.44,"maximum":3163.82,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3163.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":2390.44,"methodology":"fee schedule"}]}]},{"description":"Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation ","code_information":[{"code":"409","type":"RC"},{"code":"75805","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4864.82,"maximum":6438.74,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6438.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4864.82,"methodology":"fee schedule"}]}]},{"description":"Lymphangiotomy or other operations on lymphatic channels ","code_information":[{"code":"369","type":"RC"},{"code":"38308","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Lymphangiotomy or other operations on lymphatic channels ","code_information":[{"code":"38308","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg ","code_information":[{"code":"343","type":"RC"},{"code":"J7504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":6571.27,"maximum":11947.77,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":11947.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6571.27,"methodology":"fee schedule"}]}]},{"description":"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC ","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":3928.00,"maximum":4693.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":4693.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":3928.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."}]}]},{"description":"LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC ","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":2838.00,"maximum":3390.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3390.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":2838.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."}]}]},{"description":"Lysis intranasal synechia ","code_information":[{"code":"30560","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1813.00,"maximum":2617.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2617.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1813.00,"methodology":"case rate"}]}]},{"description":"Lysis intranasal synechia ","code_information":[{"code":"30560","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1813.00,"maximum":2617.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2617.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1813.00,"methodology":"case rate"}]}]},{"description":"Lysis of adhesions (salpingolysis, ovariolysis) ","code_information":[{"code":"369","type":"RC"},{"code":"58740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Lysis of adhesions (salpingolysis, ovariolysis) ","code_information":[{"code":"481","type":"RC"},{"code":"58740","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Macroscopic examination; parasite ","code_information":[{"code":"307","type":"RC"},{"code":"87169","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.31,"maximum":4.31,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4.31,"methodology":"fee schedule"}]}]},{"description":"Macroscopic examination; parasite ","code_information":[{"code":"87169","type":"CPT"},{"code":"923","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4.31,"maximum":4.31,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":4.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4.31,"methodology":"fee schedule"}]}]},{"description":"Magnesium ","code_information":[{"code":"301","type":"RC"},{"code":"83735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.70,"maximum":6.70,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6.70,"methodology":"fee schedule"}]}]},{"description":"Magnesium ","code_information":[{"code":"306","type":"RC"},{"code":"83735","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6.70,"maximum":6.70,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6.70,"methodology":"fee schedule"}]}]},{"description":"Magnesium ","code_information":[{"code":"83735","type":"CPT"},{"code":"923","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6.70,"maximum":6.70,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6.70,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s) ","code_information":[{"code":"611","type":"RC"},{"code":"74182","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s) ","code_information":[{"code":"616","type":"RC"},{"code":"74182","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s) ","code_information":[{"code":"616","type":"RC"},{"code":"74181","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences ","code_information":[{"code":"619","type":"RC"},{"code":"74183","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material ","code_information":[{"code":"618","type":"RC"},{"code":"73721","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences ","code_information":[{"code":"610","type":"RC"},{"code":"73723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences ","code_information":[{"code":"615","type":"RC"},{"code":"73723","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) ","code_information":[{"code":"619","type":"RC"},{"code":"73222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1215.81,"maximum":1609.16,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1609.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1215.81,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences ","code_information":[{"code":"612","type":"RC"},{"code":"73223","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences ","code_information":[{"code":"618","type":"RC"},{"code":"73223","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); with cont ","code_information":[{"code":"611","type":"RC"},{"code":"70558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":303.54,"maximum":401.74,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":401.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":303.54,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); with cont ","code_information":[{"code":"616","type":"RC"},{"code":"70558","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":303.54,"maximum":401.74,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":401.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":303.54,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without c ","code_information":[{"code":"618","type":"RC"},{"code":"70557","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":820.91,"maximum":1086.50,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":1086.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":820.91,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without c ","code_information":[{"code":"619","type":"RC"},{"code":"70559","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":303.54,"maximum":401.74,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":401.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":303.54,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s) ","code_information":[{"code":"616","type":"RC"},{"code":"70552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material ","code_information":[{"code":"616","type":"RC"},{"code":"70551","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s) ","code_information":[{"code":"611","type":"RC"},{"code":"71550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s) ","code_information":[{"code":"616","type":"RC"},{"code":"71550","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s), followed by contrast material(s) and further sequences ","code_information":[{"code":"619","type":"RC"},{"code":"71552","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) ","code_information":[{"code":"610","type":"RC"},{"code":"73719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) ","code_information":[{"code":"615","type":"RC"},{"code":"73719","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) ","code_information":[{"code":"619","type":"RC"},{"code":"73718","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) ","code_information":[{"code":"610","type":"RC"},{"code":"70540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) ","code_information":[{"code":"615","type":"RC"},{"code":"70540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s) ","code_information":[{"code":"611","type":"RC"},{"code":"72196","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s) ","code_information":[{"code":"616","type":"RC"},{"code":"72196","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) ","code_information":[{"code":"616","type":"RC"},{"code":"72195","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences ","code_information":[{"code":"619","type":"RC"},{"code":"72197","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s) ","code_information":[{"code":"612","type":"RC"},{"code":"72142","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s) ","code_information":[{"code":"618","type":"RC"},{"code":"72142","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s) ","code_information":[{"code":"610","type":"RC"},{"code":"72149","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s) ","code_information":[{"code":"615","type":"RC"},{"code":"72149","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material ","code_information":[{"code":"619","type":"RC"},{"code":"72148","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical ","code_information":[{"code":"614","type":"RC"},{"code":"72156","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar ","code_information":[{"code":"611","type":"RC"},{"code":"72158","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar ","code_information":[{"code":"616","type":"RC"},{"code":"72158","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic ","code_information":[{"code":"611","type":"RC"},{"code":"72157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic ","code_information":[{"code":"616","type":"RC"},{"code":"72157","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) ","code_information":[{"code":"611","type":"RC"},{"code":"73219","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) ","code_information":[{"code":"616","type":"RC"},{"code":"73219","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) ","code_information":[{"code":"610","type":"RC"},{"code":"73218","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) ","code_information":[{"code":"619","type":"RC"},{"code":"73218","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences ","code_information":[{"code":"614","type":"RC"},{"code":"73220","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography with contrast, spinal canal and contents ","code_information":[{"code":"619","type":"RC"},{"code":"C8931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography with contrast, upper extremity ","code_information":[{"code":"611","type":"RC"},{"code":"C8934","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography with contrast, upper extremity ","code_information":[{"code":"616","type":"RC"},{"code":"C8934","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography without contrast followed by with contrast, abdomen ","code_information":[{"code":"614","type":"RC"},{"code":"C8902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium) ","code_information":[{"code":"619","type":"RC"},{"code":"C8911","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography without contrast followed by with contrast, lower extremity ","code_information":[{"code":"610","type":"RC"},{"code":"C8914","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography without contrast followed by with contrast, lower extremity ","code_information":[{"code":"615","type":"RC"},{"code":"C8914","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography without contrast followed by with contrast, pelvis ","code_information":[{"code":"610","type":"RC"},{"code":"C8920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography without contrast followed by with contrast, pelvis ","code_information":[{"code":"619","type":"RC"},{"code":"C8920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents ","code_information":[{"code":"614","type":"RC"},{"code":"C8933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography without contrast followed by with contrast, upper extremity ","code_information":[{"code":"618","type":"RC"},{"code":"C8936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography without contrast, abdomen ","code_information":[{"code":"611","type":"RC"},{"code":"C8901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography without contrast, pelvis ","code_information":[{"code":"618","type":"RC"},{"code":"C8919","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, abdomen, with or without contrast material(s) ","code_information":[{"code":"611","type":"RC"},{"code":"74185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":508.35,"maximum":672.82,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":672.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":508.35,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, abdomen, with or without contrast material(s) ","code_information":[{"code":"616","type":"RC"},{"code":"74185","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":508.35,"maximum":672.82,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":672.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":508.35,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, head; with contrast material(s) ","code_information":[{"code":"612","type":"RC"},{"code":"70545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, head; with contrast material(s) ","code_information":[{"code":"614","type":"RC"},{"code":"70545","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, head; without contrast material(s) ","code_information":[{"code":"614","type":"RC"},{"code":"70544","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further sequences ","code_information":[{"code":"610","type":"RC"},{"code":"70546","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further sequences ","code_information":[{"code":"615","type":"RC"},{"code":"70546","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, lower extremity, with or without contrast material(s) ","code_information":[{"code":"612","type":"RC"},{"code":"73725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":504.80,"maximum":668.12,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":668.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":504.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, lower extremity, with or without contrast material(s) ","code_information":[{"code":"614","type":"RC"},{"code":"73725","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":504.80,"maximum":668.12,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":668.12,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":504.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, neck; with contrast material(s) ","code_information":[{"code":"619","type":"RC"},{"code":"70548","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, neck; without contrast material(s) ","code_information":[{"code":"612","type":"RC"},{"code":"70547","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, neck; without contrast material(s) ","code_information":[{"code":"618","type":"RC"},{"code":"70547","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, pelvis, with or without contrast material(s) ","code_information":[{"code":"619","type":"RC"},{"code":"72198","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":507.76,"maximum":672.03,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":672.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":507.76,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance angiography, upper extremity, with or without contrast material(s) ","code_information":[{"code":"614","type":"RC"},{"code":"73225","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":523.79,"maximum":693.25,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":693.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":523.79,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation lesion, intracranial for movement disorder including stereotactic navigation and frame placement when ","code_information":[{"code":"0398T","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":12129.00,"maximum":15736.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15736.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":12129.00,"methodology":"case rate"}]}]},{"description":"Magnetic resonance imaging with contrast, breast; bilateral ","code_information":[{"code":"615","type":"RC"},{"code":"C8906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":625.80,"maximum":828.27,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":828.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":625.80,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance imaging with contrast, breast; unilateral ","code_information":[{"code":"612","type":"RC"},{"code":"C8903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":303.54,"maximum":401.74,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":401.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":303.54,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance imaging with contrast, breast; unilateral ","code_information":[{"code":"618","type":"RC"},{"code":"C8903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":303.54,"maximum":401.74,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":401.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":303.54,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance imaging with inhaled hyperpolarized xenon-129 contrast agent, chest, including preparation and administration of agent ","code_information":[{"code":"610","type":"RC"},{"code":"C9791","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2125.85,"maximum":2813.63,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2813.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":2125.85,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance imaging with inhaled hyperpolarized xenon-129 contrast agent, chest, including preparation and administration of agent ","code_information":[{"code":"619","type":"RC"},{"code":"C9791","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2125.85,"maximum":2813.63,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2813.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":2125.85,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist admin ","code_information":[{"code":"611","type":"RC"},{"code":"70554","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing ","code_information":[{"code":"619","type":"RC"},{"code":"70555","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when perf ","code_information":[{"code":"618","type":"RC"},{"code":"77048","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":482.85,"maximum":639.07,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":639.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":482.85,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance imaging, breast, without contrast material; bilateral ","code_information":[{"code":"610","type":"RC"},{"code":"77047","type":"CPT"},{"code":"789346","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"gross_charge":760.85,"discounted_cash":760.85,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance imaging, breast, without contrast material; bilateral ","code_information":[{"code":"614","type":"RC"},{"code":"77047","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance imaging, breast, without contrast material; unilateral ","code_information":[{"code":"611","type":"RC"},{"code":"77046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance imaging, breast, without contrast material; unilateral ","code_information":[{"code":"616","type":"RC"},{"code":"77046","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance spectroscopy, determination and localization of discogenic pain (cervical, thoracic, or lumbar); interpretation and report ","code_information":[{"code":"0612T","type":"CPT"},{"code":"342","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":48.04,"maximum":63.59,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":63.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":48.04,"methodology":"fee schedule"}]}]},{"description":"Magnetic resonance spectroscopy, determination and localization of discogenic pain (cervical, thoracic, or lumbar); postprocessing for algorithmic analysis of biomarker data for determination of relat ","code_information":[{"code":"0611T","type":"CPT"},{"code":"340","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":391.22,"maximum":517.79,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":517.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":391.22,"methodology":"fee schedule"}]}]},{"description":"MAJOR CHEST TRAUMA WITH CC ","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":2838.00,"maximum":3390.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3390.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":2838.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."}]}]},{"description":"Malar augmentation, prosthetic material ","code_information":[{"code":"21270","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7591.00,"maximum":10673.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10673.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":7591.00,"methodology":"case rate"}]}]},{"description":"Malar augmentation, prosthetic material ","code_information":[{"code":"21270","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7591.00,"maximum":10673.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10673.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":7591.00,"methodology":"case rate"}]}]},{"description":"Malate dehydrogenase ","code_information":[{"code":"302","type":"RC"},{"code":"83775","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7.37,"maximum":7.37,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":7.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":7.37,"methodology":"fee schedule"}]}]},{"description":"MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC ","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":2838.00,"maximum":3390.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3390.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":2838.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."}]}]},{"description":"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC ","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":2838.00,"maximum":3390.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3390.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":2838.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."}]}]},{"description":"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC ","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":2838.00,"maximum":3390.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3390.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":2838.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."}]}]},{"description":"Management of liver hemorrhage; complex suture of liver wound or injury, with or without hepatic artery ligation ","code_information":[{"code":"369","type":"RC"},{"code":"47360","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Management of liver hemorrhage; complex suture of liver wound or injury, with or without hepatic artery ligation ","code_information":[{"code":"47360","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Management of liver hemorrhage; complex suture of liver wound or injury, with or without hepatic artery ligation ","code_information":[{"code":"47360","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Management of liver hemorrhage; complex suture of liver wound or injury, with or without hepatic artery ligation ","code_information":[{"code":"47360","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Management of liver hemorrhage; simple suture of liver wound or injury ","code_information":[{"code":"360","type":"RC"},{"code":"47350","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Management of liver hemorrhage; simple suture of liver wound or injury ","code_information":[{"code":"47350","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Manganese ","code_information":[{"code":"301","type":"RC"},{"code":"83785","type":"CPT"},{"code":"946926","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":26.65,"maximum":26.65,"gross_charge":310.20,"discounted_cash":310.20,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":26.65,"methodology":"fee schedule"}]}]},{"description":"Manganese ","code_information":[{"code":"306","type":"RC"},{"code":"83785","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26.65,"maximum":26.65,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":26.65,"methodology":"fee schedule"}]}]},{"description":"Manganese ","code_information":[{"code":"83785","type":"CPT"},{"code":"923","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":26.65,"maximum":26.65,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":26.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":26.65,"methodology":"fee schedule"}]}]},{"description":"Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus) ","code_information":[{"code":"27860","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":3622.00,"maximum":5069.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":3622.00,"methodology":"case rate"}]}]},{"description":"Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus) ","code_information":[{"code":"27860","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":3622.00,"maximum":5069.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":3622.00,"methodology":"case rate"}]}]},{"description":"Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices) ","code_information":[{"code":"27570","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":3622.00,"maximum":5069.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":3622.00,"methodology":"case rate"}]}]},{"description":"Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices) ","code_information":[{"code":"27570","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":3622.00,"maximum":5069.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":3622.00,"methodology":"case rate"}]}]},{"description":"Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded) ","code_information":[{"code":"23700","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":3622.00,"maximum":5069.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":3622.00,"methodology":"case rate"}]}]},{"description":"Manipulation, elbow, under anesthesia ","code_information":[{"code":"24300","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":3622.00,"maximum":5069.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":3622.00,"methodology":"case rate"}]}]},{"description":"Manipulation, finger joint, under anesthesia, each joint ","code_information":[{"code":"26340","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1813.00,"maximum":2617.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2617.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1813.00,"methodology":"case rate"}]}]},{"description":"Manipulation, hip joint, requiring general anesthesia ","code_information":[{"code":"27275","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":3622.00,"maximum":5069.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":5069.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":3622.00,"methodology":"case rate"}]}]},{"description":"Manipulation, palmar fascial cord (ie, Dupuytren's cord), post enzyme injection (eg, collagenase), single cord ","code_information":[{"code":"26341","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1813.00,"maximum":2617.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2617.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1813.00,"methodology":"case rate"}]}]},{"description":"Manometric studies through nephrostomy or pyelostomy tube, or indwelling ureteral catheter ","code_information":[{"code":"361","type":"RC"},{"code":"50396","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1921.00,"maximum":2799.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2799.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1921.00,"methodology":"case rate"}]}]},{"description":"Manometric studies through ureterostomy or indwelling ureteral catheter ","code_information":[{"code":"361","type":"RC"},{"code":"50686","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1813.00,"maximum":2617.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2617.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1813.00,"methodology":"case rate"}]}]},{"description":"Manual application of stress performed by physician or other qualified health care professional for joint radiography, including contralateral joint if indicated ","code_information":[{"code":"324","type":"RC"},{"code":"77071","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":137.53,"maximum":182.03,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":182.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":137.53,"methodology":"fee schedule"}]}]},{"description":"Manual preparation and insertion of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure) ","code_information":[{"code":"20704","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1813.00,"maximum":2617.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2617.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1813.00,"methodology":"case rate"}]}]},{"description":"Manual preparation and insertion of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure) ","code_information":[{"code":"20702","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1813.00,"maximum":2617.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2617.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1813.00,"methodology":"case rate"}]}]},{"description":"Marsupialization of sublingual salivary cyst (ranula) ","code_information":[{"code":"42409","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Marsupialization of sublingual salivary cyst (ranula) ","code_information":[{"code":"42409","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Marsupialization of urethral diverticulum, male or female ","code_information":[{"code":"361","type":"RC"},{"code":"53240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6259.00,"maximum":8552.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8552.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6259.00,"methodology":"case rate"}]}]},{"description":"Mass spectrometry and tandem mass spectrometry (eg, MS, MS/MS, MALDI, MS-TOF, QTOF), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen ","code_information":[{"code":"303","type":"RC"},{"code":"83789","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":24.11,"maximum":24.11,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":24.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":24.11,"methodology":"fee schedule"}]}]},{"description":"Mastectomy for gynecomastia ","code_information":[{"code":"19300","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); ","code_information":[{"code":"19301","type":"CPT"},{"code":"361","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); ","code_information":[{"code":"19301","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy ","code_information":[{"code":"19302","type":"CPT"},{"code":"369","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7591.00,"maximum":10673.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10673.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":7591.00,"methodology":"case rate"}]}]},{"description":"Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy ","code_information":[{"code":"19302","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7591.00,"maximum":10673.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10673.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":7591.00,"methodology":"case rate"}]}]},{"description":"Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy ","code_information":[{"code":"19302","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7591.00,"maximum":10673.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10673.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":7591.00,"methodology":"case rate"}]}]},{"description":"Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (Urban type operation) ","code_information":[{"code":"19306","type":"CPT"},{"code":"481","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (Urban type operation) ","code_information":[{"code":"19306","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Mastectomy, radical, including pectoral muscles, axillary lymph nodes ","code_information":[{"code":"19305","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Mastectomy, simple, complete ","code_information":[{"code":"19303","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6259.00,"maximum":8552.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8552.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6259.00,"methodology":"case rate"}]}]},{"description":"Mastectomy, simple, complete ","code_information":[{"code":"19303","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6259.00,"maximum":8552.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8552.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6259.00,"methodology":"case rate"}]}]},{"description":"Mastoid obliteration (separate procedure) ","code_information":[{"code":"499","type":"RC"},{"code":"69670","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7591.00,"maximum":10673.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10673.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":7591.00,"methodology":"case rate"}]}]},{"description":"Mastoidectomy; complete ","code_information":[{"code":"69502","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Mastoidectomy; modified radical ","code_information":[{"code":"361","type":"RC"},{"code":"69505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7591.00,"maximum":10673.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10673.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":7591.00,"methodology":"case rate"}]}]},{"description":"Mastoidectomy; modified radical ","code_information":[{"code":"499","type":"RC"},{"code":"69505","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":7591.00,"maximum":10673.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10673.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":7591.00,"methodology":"case rate"}]}]},{"description":"Mastopexy ","code_information":[{"code":"19316","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6259.00,"maximum":8552.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8552.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6259.00,"methodology":"case rate"}]}]},{"description":"Mastotomy with exploration or drainage of abscess, deep ","code_information":[{"code":"19020","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Mastotomy with exploration or drainage of abscess, deep ","code_information":[{"code":"19020","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Matrion, per square centimeter ","code_information":[{"code":"891","type":"RC"},{"code":"Q4201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":153.86,"maximum":279.75,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":279.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":153.86,"methodology":"fee schedule"}]}]},{"description":"Matrion, per square centimeter ","code_information":[{"code":"892","type":"RC"},{"code":"Q4201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":153.86,"maximum":279.75,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":279.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":153.86,"methodology":"fee schedule"}]}]},{"description":"Maxillectomy; without orbital exenteration ","code_information":[{"code":"31225","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging ","code_information":[{"code":"499","type":"RC"},{"code":"51798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1813.00,"maximum":2617.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2617.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1813.00,"methodology":"case rate"}]}]},{"description":"Meat fibers, feces ","code_information":[{"code":"303","type":"RC"},{"code":"89160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.85,"maximum":4.85,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4.85,"methodology":"fee schedule"}]}]},{"description":"Meatotomy, cutting of meatus (separate procedure); except infant ","code_information":[{"code":"360","type":"RC"},{"code":"53020","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Mechanical fragility, RBC ","code_information":[{"code":"301","type":"RC"},{"code":"85547","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8.60,"maximum":8.60,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":8.60,"methodology":"fee schedule"}]}]},{"description":"Mechanical fragility, RBC ","code_information":[{"code":"307","type":"RC"},{"code":"85547","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8.60,"maximum":8.60,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":8.60,"methodology":"fee schedule"}]}]},{"description":"Mechanical fragility, RBC ","code_information":[{"code":"85547","type":"CPT"},{"code":"923","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":8.60,"maximum":8.60,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":8.60,"methodology":"fee schedule"}]}]},{"description":"Mechanical fragility, RBC, shear stress and spectral analysis profiling ","code_information":[{"code":"0123U","type":"CPT"},{"code":"301","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":357.63,"maximum":357.63,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":357.63,"methodology":"fee schedule"}]}]},{"description":"Mechanical fragility, RBC, shear stress and spectral analysis profiling ","code_information":[{"code":"0123U","type":"CPT"},{"code":"306","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":357.63,"maximum":357.63,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":357.63,"methodology":"fee schedule"}]}]},{"description":"Mechanical fragility, RBC, shear stress and spectral analysis profiling ","code_information":[{"code":"0123U","type":"CPT"},{"code":"307","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":357.63,"maximum":357.63,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":357.63,"methodology":"fee schedule"}]}]},{"description":"Mechanical fragility, RBC, shear stress and spectral analysis profiling ","code_information":[{"code":"0123U","type":"CPT"},{"code":"923","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":357.63,"maximum":357.63,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":357.63,"methodology":"fee schedule"}]}]},{"description":"Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen ","code_information":[{"code":"361","type":"RC"},{"code":"36596","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10638.00,"maximum":15055.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15055.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":10638.00,"methodology":"case rate"}]}]},{"description":"Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen ","code_information":[{"code":"36596","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10638.00,"maximum":15055.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":15055.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":10638.00,"methodology":"case rate"}]}]},{"description":"MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; full sequence analysis ","code_information":[{"code":"305","type":"RC"},{"code":"81302","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":527.87,"maximum":527.87,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":527.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":527.87,"methodology":"fee schedule"}]}]},{"description":"MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; known familial variant ","code_information":[{"code":"300","type":"RC"},{"code":"81303","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":120.00,"maximum":120.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":120.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":120.00,"methodology":"fee schedule"}]}]},{"description":"Medial canthopexy (separate procedure) ","code_information":[{"code":"21280","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7591.00,"maximum":10673.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10673.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":7591.00,"methodology":"case rate"}]}]},{"description":"Medial canthopexy (separate procedure) ","code_information":[{"code":"21280","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7591.00,"maximum":10673.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10673.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":7591.00,"methodology":"case rate"}]}]},{"description":"Melphalan; oral, 2 mg ","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"636","type":"RC"},{"code":"906642","type":"CDM"},{"code":"J8600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":21.29,"maximum":38.70,"gross_charge":37.92,"discounted_cash":37.92,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":38.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":21.29,"methodology":"fee schedule"}]}]},{"description":"Membrane graft or membrane wrap, per square centimeter ","code_information":[{"code":"891","type":"RC"},{"code":"Q4205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2159.93,"maximum":3927.15,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3927.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":2159.93,"methodology":"fee schedule"}]}]},{"description":"Memoderm, dermaspan, tranzgraft or integuply, per square centimeter ","code_information":[{"code":"892","type":"RC"},{"code":"Q4126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":133.52,"maximum":242.76,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":242.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":133.52,"methodology":"fee schedule"}]}]},{"description":"Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB-FHbp), 2 or 3 dose schedule, for intramuscular use ","code_information":[{"code":"343","type":"RC"},{"code":"90621","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":376.46,"maximum":684.48,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":684.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":376.46,"methodology":"fee schedule"}]}]},{"description":"Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB-4C), 2 dose schedule, for intramuscular use ","code_information":[{"code":"892","type":"RC"},{"code":"90620","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":411.10,"maximum":747.45,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":747.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":411.10,"methodology":"fee schedule"}]}]},{"description":"Meniscectomy, partial or complete, temporomandibular joint (separate procedure) ","code_information":[{"code":"21060","type":"CPT"},{"code":"499","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":7591.00,"maximum":10673.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10673.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":7591.00,"methodology":"case rate"}]}]},{"description":"MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC ","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":2838.00,"maximum":3390.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":3390.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":2838.00,"methodology":"per diem","additional_payer_notes":"Days 3+.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."}]}]},{"description":"Metanephrines ","code_information":[{"code":"304","type":"RC"},{"code":"83835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.94,"maximum":16.94,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":16.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":16.94,"methodology":"fee schedule"}]}]},{"description":"Metatarsectomy ","code_information":[{"code":"28140","type":"CPT"},{"code":"360","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Methemalbumin ","code_information":[{"code":"300","type":"RC"},{"code":"83857","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.74,"maximum":10.74,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":10.74,"methodology":"fee schedule"}]}]},{"description":"Methemalbumin ","code_information":[{"code":"83857","type":"CPT"},{"code":"925","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":10.74,"maximum":10.74,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":10.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":10.74,"methodology":"fee schedule"}]}]},{"description":"Methotrexate ","code_information":[{"code":"309","type":"RC"},{"code":"80204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38.57,"maximum":38.57,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":38.57,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":38.57,"methodology":"fee schedule"}]}]},{"description":"Methotrexate; oral, 2.5 mg ","code_information":[{"code":"343","type":"RC"},{"code":"J8610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":0.40,"maximum":0.72,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":0.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":0.40,"methodology":"fee schedule"}]}]},{"description":"Methylprednisolone oral, per 4 mg ","code_information":[{"code":"636","type":"RC"},{"code":"J7509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":0.40,"maximum":0.72,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":0.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":0.40,"methodology":"fee schedule"}]}]},{"description":"Metyrapone panel This panel must include the following: Cortisol (82533 x 2) 11 deoxycortisol (82634 x 2) ","code_information":[{"code":"301","type":"RC"},{"code":"80436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91.16,"maximum":91.16,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":91.16,"methodology":"fee schedule"}]}]},{"description":"Metyrapone panel This panel must include the following: Cortisol (82533 x 2) 11 deoxycortisol (82634 x 2) ","code_information":[{"code":"303","type":"RC"},{"code":"80436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91.16,"maximum":91.16,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":91.16,"methodology":"fee schedule"}]}]},{"description":"Metyrapone panel This panel must include the following: Cortisol (82533 x 2) 11 deoxycortisol (82634 x 2) ","code_information":[{"code":"306","type":"RC"},{"code":"80436","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":91.16,"maximum":91.16,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":91.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":91.16,"methodology":"fee schedule"}]}]},{"description":"MGMT (O-6-methylguanine-DNA methyltransferase) (eg, glioblastoma multiforme) promoter methylation analysis ","code_information":[{"code":"302","type":"RC"},{"code":"81287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":124.64,"maximum":124.64,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":124.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":124.64,"methodology":"fee schedule"}]}]},{"description":"MGMT (O-6-methylguanine-DNA methyltransferase) (eg, glioblastoma multiforme) promoter methylation analysis ","code_information":[{"code":"304","type":"RC"},{"code":"81287","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":124.64,"maximum":124.64,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":124.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":124.64,"methodology":"fee schedule"}]}]},{"description":"Microdissection (ie, sample preparation of microscopically identified target); laser capture ","code_information":[{"code":"312","type":"RC"},{"code":"88380","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":78.86,"maximum":78.86,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":78.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":78.86,"methodology":"fee schedule"}]}]},{"description":"Microdissection (ie, sample preparation of microscopically identified target); manual ","code_information":[{"code":"311","type":"RC"},{"code":"88381","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":180.05,"maximum":180.05,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":180.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":180.05,"methodology":"fee schedule"}]}]},{"description":"Microdissection (ie, sample preparation of microscopically identified target); manual ","code_information":[{"code":"314","type":"RC"},{"code":"88381","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":180.05,"maximum":180.05,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":180.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":180.05,"methodology":"fee schedule"}]}]},{"description":"Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity ","code_information":[{"code":"309","type":"RC"},{"code":"83861","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":22.48,"maximum":22.48,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":22.48,"methodology":"fee schedule"}]}]},{"description":"Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity ","code_information":[{"code":"83861","type":"CPT"},{"code":"925","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":22.48,"maximum":22.48,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":22.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":22.48,"methodology":"fee schedule"}]}]},{"description":"Microlyte matrix, per square centimeter ","code_information":[{"code":"891","type":"RC"},{"code":"A2005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":432.25,"maximum":785.91,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":785.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":432.25,"methodology":"fee schedule"}]}]},{"description":"Microlyte matrix, per square centimeter ","code_information":[{"code":"892","type":"RC"},{"code":"A2005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":432.25,"maximum":785.91,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":785.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":432.25,"methodology":"fee schedule"}]}]},{"description":"Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) ","code_information":[{"code":"481","type":"RC"},{"code":"69990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1813.00,"maximum":2617.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2617.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1813.00,"methodology":"case rate"}]}]},{"description":"Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) ","code_information":[{"code":"490","type":"RC"},{"code":"69990","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1813.00,"maximum":2617.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2617.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1813.00,"methodology":"case rate"}]}]},{"description":"Middle ear exploration through postauricular or ear canal incision ","code_information":[{"code":"69440","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Middle ear exploration through postauricular or ear canal incision ","code_information":[{"code":"69440","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Miglustat, oral, 65 mg ","code_information":[{"code":"636","type":"RC"},{"code":"J1202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":64.35,"maximum":117.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":117.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":64.35,"methodology":"fee schedule"}]}]},{"description":"Miro3d, per cubic centimeter ","code_information":[{"code":"344","type":"RC"},{"code":"A2025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":422.37,"maximum":767.94,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":767.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":422.37,"methodology":"fee schedule"}]}]},{"description":"Mitochondrial antibody (eg, M2), each ","code_information":[{"code":"301","type":"RC"},{"code":"86381","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25.45,"maximum":25.45,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":25.45,"methodology":"fee schedule"}]}]},{"description":"Mitochondrial antibody (eg, M2), each ","code_information":[{"code":"307","type":"RC"},{"code":"86381","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25.45,"maximum":25.45,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":25.45,"methodology":"fee schedule"}]}]},{"description":"Mitochondrial antibody (eg, M2), each ","code_information":[{"code":"86381","type":"CPT"},{"code":"923","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":25.45,"maximum":25.45,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":25.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":25.45,"methodology":"fee schedule"}]}]},{"description":"Mitomycin pyelocalyceal instillation, 1 mg ","code_information":[{"code":"891","type":"RC"},{"code":"J9281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":505.99,"maximum":919.98,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":919.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":505.99,"methodology":"fee schedule"}]}]},{"description":"Mitomycin pyelocalyceal instillation, 1 mg ","code_information":[{"code":"892","type":"RC"},{"code":"J9281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":505.99,"maximum":919.98,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":919.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":505.99,"methodology":"fee schedule"}]}]},{"description":"MLH1 (mutL homolog 1) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) mRNA sequence analysis (List separately in addition to code for primary procedure) ","code_information":[{"code":"0158U","type":"CPT"},{"code":"300","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":282.88,"maximum":282.88,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":282.88,"methodology":"fee schedule"}]}]},{"description":"MLH1 (mutL homolog 1) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) mRNA sequence analysis (List separately in addition to code for primary procedure) ","code_information":[{"code":"0158U","type":"CPT"},{"code":"309","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":282.88,"maximum":282.88,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":282.88,"methodology":"fee schedule"}]}]},{"description":"MLH1 (mutL homolog 1) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) mRNA sequence analysis (List separately in addition to code for primary procedure) ","code_information":[{"code":"0158U","type":"CPT"},{"code":"925","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":282.88,"maximum":282.88,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":282.88,"methodology":"fee schedule"}]}]},{"description":"MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis ","code_information":[{"code":"305","type":"RC"},{"code":"81292","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":675.40,"maximum":675.40,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":675.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":675.40,"methodology":"fee schedule"}]}]},{"description":"MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants ","code_information":[{"code":"300","type":"RC"},{"code":"81293","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":331.00,"maximum":331.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":331.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":331.00,"methodology":"fee schedule"}]}]},{"description":"MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants ","code_information":[{"code":"305","type":"RC"},{"code":"81293","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":331.00,"maximum":331.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":331.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":331.00,"methodology":"fee schedule"}]}]},{"description":"MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; promoter methylation analysis ","code_information":[{"code":"302","type":"RC"},{"code":"81288","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":192.32,"maximum":192.32,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":192.32,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":192.32,"methodology":"fee schedule"}]}]},{"description":"Mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (List separately in addition to primary procedure) ","code_information":[{"code":"360","type":"RC"},{"code":"44139","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":6001.00,"maximum":8458.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8458.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6001.00,"methodology":"case rate"}]}]},{"description":"Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis appendage) (separate procedure) ","code_information":[{"code":"369","type":"RC"},{"code":"65125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis appendage) (separate procedure) ","code_information":[{"code":"481","type":"RC"},{"code":"65125","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4480.00,"maximum":6099.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":6099.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":4480.00,"methodology":"case rate"}]}]},{"description":"Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and h ","code_information":[{"code":"17311","type":"CPT"},{"code":"750","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1813.00,"maximum":2617.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2617.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1813.00,"methodology":"case rate"}]}]},{"description":"Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and h ","code_information":[{"code":"17313","type":"CPT"},{"code":"490","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1813.00,"maximum":2617.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2617.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1813.00,"methodology":"case rate"}]}]},{"description":"Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and h ","code_information":[{"code":"17313","type":"CPT"},{"code":"790","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":1813.00,"maximum":2617.00,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":2617.00,"methodology":"case rate"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":1813.00,"methodology":"case rate"}]}]},{"description":"Molecular cytogenetics; DNA probe, each (eg, FISH) ","code_information":[{"code":"310","type":"RC"},{"code":"88271","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21.42,"maximum":21.42,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":21.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":21.42,"methodology":"fee schedule"}]}]},{"description":"Molecular cytogenetics; interphase in situ hybridization, analyze 100-300 cells ","code_information":[{"code":"310","type":"RC"},{"code":"88275","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":51.19,"maximum":51.19,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":51.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":51.19,"methodology":"fee schedule"}]}]},{"description":"Molecular fluorescent imaging of suspicious nevus; each additional lesion (List separately in addition to code for primary procedure) ","code_information":[{"code":"0701T","type":"CPT"},{"code":"329","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":17.87,"maximum":23.65,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":23.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":17.87,"methodology":"fee schedule"}]}]},{"description":"Molecular pathology procedure, Level 1 (eg, identification of single germline variant ºeg, SNP» by techniques such as restriction enzyme digestion or melt curve analysis) ACADM (acyl-CoA dehydrogenase ","code_information":[{"code":"309","type":"RC"},{"code":"81400","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":63.96,"maximum":63.96,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":63.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":63.96,"methodology":"fee schedule"}]}]},{"description":"Molecular pathology procedure, Level 1 (eg, identification of single germline variant ºeg, SNP» by techniques such as restriction enzyme digestion or melt curve analysis) ACADM (acyl-CoA dehydrogenase ","code_information":[{"code":"81400","type":"CPT"},{"code":"925","type":"RC"}],"standard_charges":[{"setting":"outpatient","minimum":63.96,"maximum":63.96,"payers_information":[{"payer_name":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":63.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":63.96,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only ","code_information":[{"code":"L2755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":152.27,"maximum":163.15,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":163.15,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":153.83,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":158.49,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":155.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":152.27,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, offset knee joint, heavy duty, each joint ","code_information":[{"code":"L2395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":200.43,"maximum":214.75,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":204.52,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":204.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":204.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":204.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":204.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":204.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":204.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":204.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":204.52,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":214.75,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":204.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":202.47,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":208.61,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":204.52,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":204.52,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":204.52,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":204.52,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":204.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":200.43,"methodology":"fee schedule"}]}]},{"description":"Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or witho ","code_information":[{"code":"L6696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1539.48,"maximum":1649.45,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1649.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1555.19,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1602.32,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1539.48,"methodology":"fee schedule"}]}]},{"description":"Addition, exoskeletal knee-shin system, single axis, fluid swing phase control ","code_information":[{"code":"L5724","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1812.18,"maximum":1941.62,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1849.16,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1849.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1849.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1849.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1849.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1849.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1849.16,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1849.16,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1849.16,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1941.62,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1849.16,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1830.67,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1886.14,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1849.16,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1849.16,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1849.16,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1849.16,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1849.16,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1812.18,"methodology":"fee schedule"}]}]},{"description":"Alpha-fetoprotein (AFP); amniotic fluid ","code_information":[{"code":"82106","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.66,"maximum":115.83,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":17.34,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":115.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":115.83,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":111.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":17.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16.66,"methodology":"fee schedule"}]}]},{"description":"Ankle foot orthosis, spring wire, dorsiflexion assist calf band, custom fabricated ","code_information":[{"code":"L1900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":317.19,"maximum":339.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":323.66,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":323.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":323.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":323.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":323.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":323.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":323.66,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":323.66,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":323.66,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":339.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":323.66,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":320.42,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":330.13,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":323.66,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":323.66,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":323.66,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":323.66,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":323.66,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":317.19,"methodology":"fee schedule"}]}]},{"description":"Antibody; Toxoplasma, IgM ","code_information":[{"code":"86778","type":"CPT"},{"code":"903095","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":14.12,"maximum":119.79,"gross_charge":80.53,"discounted_cash":80.53,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":15.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14.27,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":14.70,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":119.79,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":119.79,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":114.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":14.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14.12,"methodology":"fee schedule"}]}]},{"description":"ATXN7 (ataxin 7) (eg, spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (eg, expanded) alleles ","code_information":[{"code":"81181","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134.26,"maximum":391.05,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":135.63,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":391.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":391.05,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":375.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":134.26,"methodology":"fee schedule"}]}]},{"description":"Bed side rails, full length ","code_information":[{"code":"E0310","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":130.64,"maximum":139.98,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":133.31,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":133.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":133.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":133.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":133.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":133.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":133.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":133.31,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":133.31,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":139.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":133.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":131.98,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":135.98,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":133.31,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":133.31,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":133.31,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":133.31,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":133.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":130.64,"methodology":"fee schedule"}]}]},{"description":"Breast prosthesis, silicone or equal, with integral adhesive ","code_information":[{"code":"L8031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":408.92,"maximum":438.13,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":417.27,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":417.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":417.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":417.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":417.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":417.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":417.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":417.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":417.27,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":438.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":417.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":413.10,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":425.62,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":417.27,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":417.27,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":417.27,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":417.27,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":417.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":408.92,"methodology":"fee schedule"}]}]},{"description":"Cardiology (heart transplant), mRNA, gene expression profiling by real-time quantitative PCR of 20 genes (11 content and 9 housekeeping), utilizing subfraction of peripheral blood, algorithm reported ","code_information":[{"code":"81595","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3175.20,"maximum":10299.96,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3240.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3240.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3240.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3240.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3240.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3240.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3240.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3240.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3240.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3402.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3240.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3207.60,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3304.80,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3240.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":10299.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":10299.96,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3240.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":9883.80,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3240.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3240.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3240.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3175.20,"methodology":"fee schedule"}]}]},{"description":"Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); ","code_information":[{"code":"86152","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":35.15,"maximum":263.32,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":250.78,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":250.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":250.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":250.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":250.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":250.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":250.78,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":250.78,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":250.78,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":263.32,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":250.78,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":248.27,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":255.80,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":250.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":250.78,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":250.78,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":250.78,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":250.78,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":245.76,"methodology":"fee schedule"}]}]},{"description":"Clotting inhibitors or anticoagulants; antithrombin III, activity ","code_information":[{"code":"85300","type":"CPT"},{"code":"946984","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.61,"maximum":46.53,"gross_charge":274.43,"discounted_cash":274.43,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.73,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.09,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":46.53,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":44.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":11.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.61,"methodology":"fee schedule"}]}]},{"description":"Commode seat, wheelchair ","code_information":[{"code":"E0968","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":23.96,"maximum":25.67,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":24.21,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":24.94,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":24.45,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":23.96,"methodology":"fee schedule"}]}]},{"description":"Corrugated tubing, disposable, used with large volume nebulizer, 100 feet ","code_information":[{"code":"A7010","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":18.42,"maximum":19.74,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19.74,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":18.61,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":19.18,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":18.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18.42,"methodology":"fee schedule"}]}]},{"description":"Cyanide ","code_information":[{"code":"82600","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":13.30,"maximum":20.37,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":20.37,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":19.21,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":19.79,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":13.86,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":13.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":19.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19.01,"methodology":"fee schedule"}]}]},{"description":"Drive belt for power wheelchair, replacement only ","code_information":[{"code":"K0098","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":26.56,"maximum":28.46,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":28.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":26.83,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":27.64,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":27.10,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":26.56,"methodology":"fee schedule"}]}]},{"description":"Electrical stimulation device used for cancer treatment, includes all accessories, any type ","code_information":[{"code":"E0766","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR|KF","modifiers_description":"Rental (use the RR modifier when DME is to be rented)|Item designated by FDA as Class III device","setting":"outpatient","minimum":15373.26,"maximum":16471.35,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":15687.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":15687.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":15687.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":15687.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":15687.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":15687.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":15687.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":15687.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":15687.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":16471.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":15687.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":15530.13,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16000.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":15687.00,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":15687.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":15687.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":15687.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":15687.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15373.26,"methodology":"fee schedule"}]}]},{"description":"F9 (coagulation factor IX) (eg, hemophilia B), full gene sequence ","code_information":[{"code":"81238","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":375.25,"maximum":630.00,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":630.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":594.00,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":612.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":391.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":391.05,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":375.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":600.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":588.00,"methodology":"fee schedule"}]}]},{"description":"Fibrin degradation products, D-dimer; quantitative ","code_information":[{"code":"85379","type":"CPT"},{"code":"903424","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":9.98,"maximum":18.81,"gross_charge":292.31,"discounted_cash":292.31,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":10.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":10.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":18.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":18.81,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":18.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":10.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9.98,"methodology":"fee schedule"}]}]},{"description":"Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each ","code_information":[{"code":"L3170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":59.31,"maximum":63.55,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":60.52,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":60.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":60.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":60.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":60.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":60.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":60.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":60.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":60.52,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":63.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":60.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":59.91,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":61.73,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":60.52,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":60.52,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":60.52,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":60.52,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":60.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":59.31,"methodology":"fee schedule"}]}]},{"description":"General use wheelchair seat cushion, width 22 inches or greater, any depth ","code_information":[{"code":"E2602","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":98.25,"maximum":105.26,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":100.25,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":100.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":100.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":100.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":100.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":100.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":100.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":100.25,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":100.25,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":105.26,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":100.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":99.25,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":102.25,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":100.25,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":100.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":100.25,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":100.25,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":100.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":98.25,"methodology":"fee schedule"}]}]},{"description":"Gradient  compression glove, custom, heavy weight, each ","code_information":[{"code":"A6580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":288.08,"maximum":308.66,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":308.66,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":291.02,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":299.84,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":293.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":288.08,"methodology":"fee schedule"}]}]},{"description":"Gradient compression stocking, thigh length, 30-40 mmhg, custom, each ","code_information":[{"code":"A6557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":287.42,"maximum":307.95,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":293.29,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":293.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":293.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":293.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":293.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":293.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":293.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":293.29,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":293.29,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":307.95,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":293.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":290.36,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":299.16,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":293.29,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":293.29,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":293.29,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":293.29,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":293.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":287.42,"methodology":"fee schedule"}]}]},{"description":"Heel, new rubber, standard ","code_information":[{"code":"L3460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":40.06,"maximum":42.92,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":42.92,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":40.47,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":41.70,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":40.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":40.06,"methodology":"fee schedule"}]}]},{"description":"Hemolysins and agglutinins; auto, screen, each ","code_information":[{"code":"86940","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8.59,"maximum":255.42,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":9.21,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":8.68,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":8.95,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":255.42,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":245.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":8.59,"methodology":"fee schedule"}]}]},{"description":"Hip knee ankle foot orthosis, torsion control, bilateral torsion cables, hip joint, pelvic band/belt, custom fabricated ","code_information":[{"code":"L2050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":568.25,"maximum":608.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":579.85,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":579.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":579.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":579.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":579.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":579.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":579.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":579.85,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":579.85,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":608.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":579.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":574.05,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":591.45,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":579.85,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":579.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":579.85,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":579.85,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":579.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":568.25,"methodology":"fee schedule"}]}]},{"description":"Homovanillic acid (HVA) ","code_information":[{"code":"83150","type":"CPT"},{"code":"902803","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":12.35,"maximum":23.53,"gross_charge":357.94,"discounted_cash":357.94,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":23.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22.19,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":22.86,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":21.96,"methodology":"fee schedule"}]}]},{"description":"Hydrocolloid dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing ","code_information":[{"code":"A6235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22.49,"maximum":24.10,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":24.10,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22.72,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":23.41,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22.95,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22.49,"methodology":"fee schedule"}]}]},{"description":"Immunoglobulin paraprotein (M-protein), qualitative, immunoprecipitation and mass spectrometry, blood or urine, including isotype ","code_information":[{"code":"0077U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42.56,"maximum":123.75,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":45.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":43.00,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":44.30,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":123.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":123.75,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":118.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":43.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":42.56,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay ºEIA», enzyme-linked immunosorbent assay ºELISA», fluorescence immunoassay ºFIA», immunochemiluminometric assay ºIMC ","code_information":[{"code":"87339","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":15.68,"maximum":35.64,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":16.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16.32,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":35.64,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":34.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":15.68,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; direct probe technique, each organism ","code_information":[{"code":"87797","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":29.43,"maximum":99.99,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":31.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":29.73,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":30.63,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":95.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":30.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":29.43,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique ","code_information":[{"code":"87651","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":34.39,"maximum":407.88,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":407.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":407.88,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":391.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":34.39,"methodology":"fee schedule"}]}]},{"description":"Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, plaster socket, direct formed ","code_information":[{"code":"L5505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2262.19,"maximum":2423.78,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2308.36,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2308.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2308.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2308.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2308.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2308.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2308.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2308.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2308.36,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2423.78,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2308.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2285.28,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2354.53,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2308.36,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2308.36,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2308.36,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2308.36,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2308.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2262.19,"methodology":"fee schedule"}]}]},{"description":"Knee disarticulation (or through knee), molded socket, external knee joints, shin, sach foot ","code_information":[{"code":"L5150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4467.89,"maximum":4787.02,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4559.07,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4559.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4559.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4559.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4559.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4559.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4559.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4559.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4559.07,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4787.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4559.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4513.48,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4650.25,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4559.07,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4559.07,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4559.07,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4559.07,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4559.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4467.89,"methodology":"fee schedule"}]}]},{"description":"Actin (smooth muscle) antibody (ASMA), each ","code_information":[{"code":"116975","type":"CDM"},{"code":"86015","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.81,"maximum":21.78,"gross_charge":39.00,"discounted_cash":39.00,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.93,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.29,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":21.78,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":21.78,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":20.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":12.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.81,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type ","code_information":[{"code":"L5926","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":692.86,"maximum":742.35,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":707.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":707.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":707.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":707.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":707.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":707.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":707.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":707.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":707.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":742.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":707.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":699.93,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":721.14,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":707.00,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":707.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":707.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":707.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":707.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":692.86,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, pelvic control, hip joint, clevis or thrust bearing, lock, each ","code_information":[{"code":"L2610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":274.11,"maximum":293.69,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":279.70,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":279.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":279.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":279.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":279.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":279.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":279.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":279.70,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":279.70,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":293.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":279.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":276.90,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":285.29,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":279.70,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":279.70,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":279.70,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":279.70,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":279.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":274.11,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, thoracic control, thoracic band ","code_information":[{"code":"L2660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":267.93,"maximum":287.07,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":273.40,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":273.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":273.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":273.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":273.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":273.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":273.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":273.40,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":273.40,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":287.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":273.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":270.67,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":278.87,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":273.40,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":273.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":273.40,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":273.40,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":273.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":267.93,"methodology":"fee schedule"}]}]},{"description":"Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) ","code_information":[{"code":"L5940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":768.24,"maximum":823.12,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":823.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":776.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":799.60,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":783.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":768.24,"methodology":"fee schedule"}]}]},{"description":"All lower extremity prosthesis, solid ankle cushion heel (sach) foot, replacement only ","code_information":[{"code":"L5971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":260.81,"maximum":279.44,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":266.13,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":266.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":266.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":266.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":266.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":266.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":266.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":266.13,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":266.13,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":279.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":266.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":263.47,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":271.45,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":266.13,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":266.13,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":266.13,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":266.13,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":266.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":260.81,"methodology":"fee schedule"}]}]},{"description":"Antibody; bacterium, not elsewhere specified ","code_information":[{"code":"86609","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.62,"maximum":52.47,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12.75,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.14,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":52.47,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":50.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":12.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.62,"methodology":"fee schedule"}]}]},{"description":"Antibody; Helicobacter pylori ","code_information":[{"code":"86677","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.51,"maximum":28.71,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.68,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":17.19,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":28.71,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":28.71,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":27.55,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16.51,"methodology":"fee schedule"}]}]},{"description":"Antistreptolysin 0; screen ","code_information":[{"code":"86063","type":"CPT"},{"code":"902966","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.65,"maximum":32.67,"gross_charge":312.14,"discounted_cash":312.14,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":6.06,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.71,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.89,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":32.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":32.67,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":31.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.65,"methodology":"fee schedule"}]}]},{"description":"Bedside drainage bottle with or without tubing, rigid or expandable, each ","code_information":[{"code":"A5102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30.17,"maximum":32.33,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":32.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":30.48,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":31.41,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":30.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":30.17,"methodology":"fee schedule"}]}]},{"description":"BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) mRNA sequence analysis (List separately in addition to code for primary procedure) ","code_information":[{"code":"0138U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":458.96,"maximum":1339.47,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":468.33,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":468.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":468.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":468.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":468.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":468.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":468.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":468.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":468.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":491.75,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":468.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":463.65,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":477.70,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":468.33,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1339.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1339.47,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":468.33,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1285.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":468.33,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":468.33,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":468.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":458.96,"methodology":"fee schedule"}]}]},{"description":"Calculus; X-ray diffraction ","code_information":[{"code":"82370","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.27,"maximum":16.83,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.15,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12.39,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.77,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":16.83,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":16.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.27,"methodology":"fee schedule"}]}]},{"description":"Cast supplies, short leg splint, adult (11 years +), fiberglass ","code_information":[{"code":"Q4046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":22.31,"maximum":23.91,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":23.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22.54,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":23.23,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":22.31,"methodology":"fee schedule"}]}]},{"description":"Chromium ","code_information":[{"code":"82495","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.40,"maximum":21.29,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":21.29,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":20.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":20.69,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":11.88,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":11.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":20.28,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19.87,"methodology":"fee schedule"}]}]},{"description":"Collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each ","code_information":[{"code":"A6022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28.12,"maximum":30.12,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":30.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":28.40,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":29.26,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":28.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":28.12,"methodology":"fee schedule"}]}]},{"description":"Creatine ","code_information":[{"code":"82540","type":"CPT"},{"code":"946852","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":4.55,"maximum":34.65,"gross_charge":591.01,"discounted_cash":591.01,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4.87,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.59,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":33.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.55,"methodology":"fee schedule"}]}]},{"description":"Culture, typing; identification of blood pathogen and resistance typing, when performed, by nucleic acid (DNA or RNA) probe, multiplexed amplified probe technique including multiplex reverse transcrip ","code_information":[{"code":"87154","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54.15,"maximum":228.96,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":228.96,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":215.88,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":222.42,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":56.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":56.43,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":218.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":213.70,"methodology":"fee schedule"}]}]},{"description":"Drug metabolism (adverse drug reactions and drug response), targeted sequence analysis (ie, CYP1A2, CYP2C19, CYP2C9, CYP2D6, CYP3A4, CYP3A5, CYP4F2, SLCO1B1, VKORC1 and rs12777823) ","code_information":[{"code":"0029U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":727.42,"maximum":2123.55,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":779.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":734.85,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":757.12,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2123.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2123.55,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2037.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":727.42,"methodology":"fee schedule"}]}]},{"description":"Electric hand, switch or myoelectric controlled, adult ","code_information":[{"code":"L7007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3952.64,"maximum":4234.98,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4033.31,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4033.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4033.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4033.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4033.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4033.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4033.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4033.31,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4033.31,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4234.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4033.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3992.98,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4113.98,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4033.31,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4033.31,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4033.31,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4033.31,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4033.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3952.64,"methodology":"fee schedule"}]}]},{"description":"External urinary catheters; disposable, with wicking material, for use with suction pump, per month ","code_information":[{"code":"A6590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":418.66,"maximum":448.56,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":448.56,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":422.93,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":435.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":427.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":418.66,"methodology":"fee schedule"}]}]},{"description":"Fetal congenital abnormalities, biochemical assays of three analytes (AFP, uE3, hCG ºany form»), utilizing maternal serum, algorithm reported as a risk score ","code_information":[{"code":"81510","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":54.43,"maximum":197.01,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":58.32,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":54.98,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":56.65,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":197.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":197.01,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":189.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":55.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":54.43,"methodology":"fee schedule"}]}]},{"description":"Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing ","code_information":[{"code":"A6212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":12.98,"maximum":13.91,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":13.12,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.52,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":13.25,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.98,"methodology":"fee schedule"}]}]},{"description":"Gastrin ","code_information":[{"code":"82941","type":"CPT"},{"code":"902690","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":17.28,"maximum":27.72,"gross_charge":590.60,"discounted_cash":590.60,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":18.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":17.45,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":17.98,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26.60,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":17.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":17.28,"methodology":"fee schedule"}]}]},{"description":"Gradient  compression arm sleeve, custom, heavy weight, each ","code_information":[{"code":"A6577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":149.65,"maximum":160.34,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":152.70,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":152.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":152.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":152.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":152.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":152.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":152.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":152.70,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":152.70,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":160.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":152.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":151.17,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":155.75,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":152.70,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":152.70,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":152.70,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":152.70,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":152.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":149.65,"methodology":"fee schedule"}]}]},{"description":"Hallus-valgus night dynamic splint, prefabricated, off-the-shelf ","code_information":[{"code":"L3100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":50.39,"maximum":53.99,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":53.99,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":50.91,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":52.45,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":50.39,"methodology":"fee schedule"}]}]},{"description":"Heel, pad and depression for spur ","code_information":[{"code":"L3480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":72.69,"maximum":77.88,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":77.88,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":73.43,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":75.65,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":74.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":72.69,"methodology":"fee schedule"}]}]},{"description":"Hemi-facial prosthesis, provided by a non-physician ","code_information":[{"code":"L8044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4530.83,"maximum":4854.47,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4623.30,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4623.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4623.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4623.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4623.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4623.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4623.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4623.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4623.30,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4854.47,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4623.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4577.07,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4715.77,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4623.30,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4623.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4623.30,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4623.30,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4623.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4530.83,"methodology":"fee schedule"}]}]},{"description":"Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer, hereditary pancreatic cancer, hereditary prostate cancer), genomic s ","code_information":[{"code":"81432","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":665.47,"maximum":7752.69,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":713.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":672.26,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":692.63,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7752.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7752.69,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7439.45,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":679.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":665.47,"methodology":"fee schedule"}]}]},{"description":"HLA Class II typing, high resolution (ie, alleles or allele groups); one locus (eg, HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1), each ","code_information":[{"code":"81382","type":"CPT"},{"code":"956911","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":121.21,"maximum":988.02,"gross_charge":3381.65,"discounted_cash":3381.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":129.86,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":122.44,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":126.15,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":988.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":988.02,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":948.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":123.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":121.21,"methodology":"fee schedule"}]}]},{"description":"Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, shoulder disarticulation or interscapular ","code_information":[{"code":"L6384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2521.01,"maximum":2701.08,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2572.46,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2572.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2572.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2572.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2572.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2572.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2572.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2572.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2572.46,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2701.08,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2572.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2546.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2623.91,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2572.46,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2572.46,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2572.46,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2572.46,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2572.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2521.01,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Influenza ","code_information":[{"code":"87804","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.22,"maximum":124.74,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.38,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16.88,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":124.74,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":124.74,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":119.70,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16.22,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, quantification ","code_information":[{"code":"87517","type":"CPT"},{"code":"940545","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":41.98,"maximum":56.43,"gross_charge":412.50,"discounted_cash":412.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":44.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":42.41,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":56.43,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":56.43,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":54.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":41.98,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, amplified probe technique ","code_information":[{"code":"87581","type":"CPT"},{"code":"903186","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":34.39,"maximum":99.99,"gross_charge":363.00,"discounted_cash":363.00,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":95.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":34.39,"methodology":"fee schedule"}]}]},{"description":"Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, other region (eg, integrase, fusion) ","code_information":[{"code":"87906","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":126.16,"maximum":736.56,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":135.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":127.44,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":131.30,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":736.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":736.56,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":706.80,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":128.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":126.16,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity orthosis, suspension sleeve ","code_information":[{"code":"L2397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":138.84,"maximum":148.75,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":141.67,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":141.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":141.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":141.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":141.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":141.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":141.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":141.67,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":141.67,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":148.75,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":141.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":140.25,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":144.50,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":141.67,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":141.67,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":141.67,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":141.67,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":141.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":138.84,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, ischial containment/narrow m-l socket ","code_information":[{"code":"L5649","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2435.16,"maximum":2609.10,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2484.86,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2484.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2484.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2484.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2484.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2484.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2484.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2484.86,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2484.86,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2609.10,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2484.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2460.01,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2534.56,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2484.86,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2484.86,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2484.86,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2484.86,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2484.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2435.16,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, user adjustable, mechanical, residual limb volume management system ","code_information":[{"code":"L5783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":2955.60,"maximum":3166.72,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3166.72,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2985.76,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3076.24,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3015.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2955.60,"methodology":"fee schedule"}]}]},{"description":"Additions to lower extremity, total contact, above knee or knee disarticulation socket ","code_information":[{"code":"L5650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":747.68,"maximum":801.09,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":762.94,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":762.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":762.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":762.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":762.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":762.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":762.94,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":762.94,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":762.94,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":801.09,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":762.94,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":755.31,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":778.20,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":762.94,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":762.94,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":762.94,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":762.94,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":762.94,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":747.68,"methodology":"fee schedule"}]}]},{"description":"All lower extremity prostheses, foot, flexible keel ","code_information":[{"code":"L5972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":505.70,"maximum":541.82,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":516.02,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":516.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":516.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":516.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":516.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":516.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":516.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":516.02,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":516.02,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":541.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":516.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":510.86,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":526.34,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":516.02,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":516.02,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":516.02,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":516.02,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":516.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":505.70,"methodology":"fee schedule"}]}]},{"description":"Amiodarone ","code_information":[{"code":"80151","type":"CPT"},{"code":"903218","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":18.27,"maximum":213.84,"gross_charge":393.75,"discounted_cash":393.75,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":18.45,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":19.01,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":213.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":213.84,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":205.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18.27,"methodology":"fee schedule"}]}]},{"description":"Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, Flow cytometry); semi-quantitative panel (eg, titer), HLA Class II ","code_information":[{"code":"86835","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":224.20,"maximum":339.11,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":339.11,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":319.73,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":329.42,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":233.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":233.64,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":224.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":322.96,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":316.50,"methodology":"fee schedule"}]}]},{"description":"Antibody; mucormycosis ","code_information":[{"code":"86732","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.70,"maximum":34.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":15.75,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":33.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":15.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14.70,"methodology":"fee schedule"}]}]},{"description":"AR (androgen receptor) (eg, spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; characterization of alleles (eg, expanded size or methylation status) ","code_information":[{"code":"81204","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":129.20,"maximum":143.85,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":135.63,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":134.64,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":134.64,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":129.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":134.26,"methodology":"fee schedule"}]}]},{"description":"Bile acids; cholylglycine ","code_information":[{"code":"82240","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":26.05,"maximum":27.91,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":27.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":26.31,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":27.11,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26.60,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":26.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":26.05,"methodology":"fee schedule"}]}]},{"description":"CACNA1A, full gene analysis, including small sequence changes in exonic and intronic regions, deletions duplications, Short Tandem Requests (STR) gene expansions, mobile element insertions, and varian ","code_information":[{"code":"0231U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":829.34,"maximum":2420.55,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":888.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":837.81,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":863.20,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2420.55,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2420.55,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2322.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":846.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":829.34,"methodology":"fee schedule"}]}]},{"description":"Cast supplies, long leg cylinder cast, pediatric (0-10 years), fiberglass ","code_information":[{"code":"Q4036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":40.09,"maximum":42.96,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":42.96,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":40.50,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":41.73,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":40.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":40.09,"methodology":"fee schedule"}]}]},{"description":"CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; duplication/deletion variants ","code_information":[{"code":"81222","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":426.37,"maximum":692.01,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":456.82,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":430.72,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":443.77,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":692.01,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":692.01,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":664.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":435.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":426.37,"methodology":"fee schedule"}]}]},{"description":"Coagulation time; other methods ","code_information":[{"code":"85348","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.40,"maximum":36.63,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.45,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4.58,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.40,"methodology":"fee schedule"}]}]},{"description":"Comparative analysis using Short Tandem Repeat (STR) markers; patient and comparative specimen (eg, pre-transplant recipient and donor germline testing, post-transplant non-hematopoietic recipient ger ","code_information":[{"code":"81265","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":228.41,"maximum":566.28,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":244.72,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":230.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":237.73,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":566.28,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":566.28,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":543.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":233.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":228.41,"methodology":"fee schedule"}]}]},{"description":"Coronary artery disease, mRNA, gene expression profiling by real-time RT-PCR of 23 genes, utilizing whole peripheral blood, algorithm reported as a risk score ","code_information":[{"code":"81493","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1029.00,"maximum":2677.95,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1102.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1039.50,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1071.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2677.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2677.95,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2569.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1050.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1029.00,"methodology":"fee schedule"}]}]},{"description":"Cystatin C ","code_information":[{"code":"82610","type":"CPT"},{"code":"944064","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":17.10,"maximum":19.45,"gross_charge":438.48,"discounted_cash":438.48,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":18.33,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":18.89,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":17.82,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":17.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":18.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18.15,"methodology":"fee schedule"}]}]},{"description":"Drug metabolism or processing (mult conditions), whole blood or buccal specimen, DNA analysis, 27 gene report, with variant analysis, including reported phenotypes and impacted gene-drug interactions ","code_information":[{"code":"0349U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":727.42,"maximum":779.38,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":779.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":734.85,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":757.12,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":742.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":727.42,"methodology":"fee schedule"}]}]},{"description":"Electronic elbow, adolescent, variety village or equal, switch controlled ","code_information":[{"code":"L7185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7331.75,"maximum":7855.45,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":7481.38,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":7481.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":7481.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":7481.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":7481.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":7481.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":7481.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":7481.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":7481.38,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":7855.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":7481.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7406.57,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":7631.01,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":7481.38,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":7481.38,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":7481.38,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":7481.38,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":7481.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7331.75,"methodology":"fee schedule"}]}]},{"description":"Estrogens; total ","code_information":[{"code":"82672","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":21.27,"maximum":175.23,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":21.70,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":21.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":21.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":21.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":21.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":21.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":21.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":21.70,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":21.70,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":22.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":21.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":22.13,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":21.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":175.23,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":21.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":168.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":21.70,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":21.70,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":21.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":21.27,"methodology":"fee schedule"}]}]},{"description":"Foot, abduction rotation bar, without shoes ","code_information":[{"code":"L3150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":94.87,"maximum":101.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":96.81,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":96.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":96.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":96.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":96.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":96.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":96.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":96.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":96.81,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":101.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":96.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":95.84,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":98.75,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":96.81,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":96.81,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":96.81,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":96.81,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":96.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":94.87,"methodology":"fee schedule"}]}]},{"description":"Leukocyte alkaline phosphatase with count ","code_information":[{"code":"85540","type":"CPT"},{"code":"903387","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":8.43,"maximum":36.63,"gross_charge":226.71,"discounted_cash":226.71,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":9.03,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":8.51,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":8.77,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":8.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":8.43,"methodology":"fee schedule"}]}]},{"description":"Liver disease, analysis of 3 biomarkers (hyaluronic acid ºHA», procollagen III amino terminal peptide ºPIIINP», tissue inhibitor of metalloproteinase 1 ºTIMP-1»), using immunoassays, utilizing serum, ","code_information":[{"code":"81517","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":172.67,"maximum":185.00,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":185.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":174.43,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":179.71,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":176.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":172.67,"methodology":"fee schedule"}]}]},{"description":"Manual wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each ","code_information":[{"code":"E2222","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":24.50,"maximum":26.25,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":26.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":24.75,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":25.50,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":25.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":24.50,"methodology":"fee schedule"}]}]},{"description":"MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants ","code_information":[{"code":"81296","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":330.98,"maximum":1931.49,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":354.62,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":334.35,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":344.48,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1931.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1931.49,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1853.45,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":337.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":330.98,"methodology":"fee schedule"}]}]},{"description":"Neurology, cerebrospinal fluid, detection of misfolded a-synuclein protein by see amplification assay, qualitative ","code_information":[{"code":"0393U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":530.17,"maximum":568.04,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":568.04,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":535.58,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":551.81,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":540.99,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":530.17,"methodology":"fee schedule"}]}]},{"description":"Oncology (oral and/or oropharyngeal cancer), gene expression profiling by RNA sequencing at least 20 molecular features, saliva, algorithm reported as positive or negative for signature associated wit ","code_information":[{"code":"0296U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1911.00,"maximum":2047.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2047.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1930.50,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1989.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1950.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1911.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (tumor of unknown origin), mRNA, gene expression profiling by real-time RT-PCR of 92 genes (87 content and 5 housekeeping) to classify tumor into main cancer type and subtype, utilizing forma ","code_information":[{"code":"81540","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1590.30,"maximum":3937.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3937.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3712.50,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3825.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1657.26,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1657.26,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1590.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3750.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3675.00,"methodology":"fee schedule"}]}]},{"description":"Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each ","code_information":[{"code":"A4422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":0.15,"maximum":0.16,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":0.16,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":0.15,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":0.15,"methodology":"fee schedule"}]}]},{"description":"Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each ","code_information":[{"code":"A4434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":5.03,"maximum":5.39,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.08,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.23,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.03,"methodology":"fee schedule"}]}]},{"description":"Pessary, reusable, rubber, any type ","code_information":[{"code":"A4561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":27.63,"maximum":29.60,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":29.60,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":27.91,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":28.75,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":28.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":27.63,"methodology":"fee schedule"}]}]},{"description":"Positioning wheelchair seat cushion, width 22 inches or greater, any depth ","code_information":[{"code":"E2606","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":391.23,"maximum":419.17,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":399.21,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":399.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":399.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":399.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":399.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":399.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":399.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":399.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":399.21,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":419.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":399.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":395.22,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":407.19,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":399.21,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":399.21,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":399.21,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":399.21,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":399.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":391.23,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair, group 2 heavy duty, multiple power option, sling/solid seat/back, patient weight capacity 301 to 450 pounds ","code_information":[{"code":"K0843","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":556.11,"maximum":595.83,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":567.46,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":567.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":567.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":567.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":567.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":567.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":567.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":567.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":567.46,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":595.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":567.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":561.79,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":578.81,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":567.46,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":567.46,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":567.46,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":567.46,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":567.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":556.11,"methodology":"fee schedule"}]}]},{"description":"Primidone ","code_information":[{"code":"80188","type":"CPT"},{"code":"903223","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":16.26,"maximum":43.56,"gross_charge":372.87,"discounted_cash":372.87,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.42,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.42,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16.92,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":43.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":43.56,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":41.80,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.59,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16.26,"methodology":"fee schedule"}]}]},{"description":"Rare DS Whl Xom & Mitochdrl DNA Seq Alys Ea Cmprtr ","code_information":[{"code":"0215U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2523.16,"maximum":7365.60,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2703.38,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2548.90,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2626.14,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":7365.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":7365.60,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":7068.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2574.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2523.16,"methodology":"fee schedule"}]}]},{"description":"Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each ","code_information":[{"code":"A4234","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":2.31,"maximum":2.48,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2.34,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2.31,"methodology":"fee schedule"}]}]},{"description":"Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision ","code_information":[{"code":"G0144","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":43.09,"maximum":57.42,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":46.17,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":43.53,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":44.85,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":57.42,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":55.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":43.97,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":43.09,"methodology":"fee schedule"}]}]},{"description":"Shoulder elbow wrist hand finger orthosis, shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment ","code_information":[{"code":"L3975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1782.48,"maximum":1909.80,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1818.86,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1818.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1818.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1818.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1818.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1818.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1818.86,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1818.86,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1818.86,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1909.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1818.86,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1800.67,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1855.24,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1818.86,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1818.86,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1818.86,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1818.86,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1818.86,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1782.48,"methodology":"fee schedule"}]}]},{"description":"Speech generating device, synthesized speech, permitting multiple methods of message formulation and multiple methods of device access ","code_information":[{"code":"E2510","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":9050.22,"maximum":9696.67,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":9234.92,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":9234.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":9234.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":9234.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":9234.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":9234.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":9234.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":9234.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":9234.92,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":9696.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":9234.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9142.57,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":9419.62,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":9234.92,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":9234.92,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":9234.92,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":9234.92,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":9234.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9050.22,"methodology":"fee schedule"}]}]},{"description":"Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens ","code_information":[{"code":"V2113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":73.06,"maximum":78.28,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":78.28,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":73.80,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":76.04,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":74.55,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":73.06,"methodology":"fee schedule"}]}]},{"description":"Terminal device, hand, mechanical, voluntary closing, any material, any size ","code_information":[{"code":"L6709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1773.93,"maximum":1900.64,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1810.13,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1810.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1810.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1810.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1810.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1810.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1810.13,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1810.13,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1810.13,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1900.64,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1810.13,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1792.03,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1846.33,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1810.13,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1810.13,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1810.13,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1810.13,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1810.13,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1773.93,"methodology":"fee schedule"}]}]},{"description":"Topiramate ","code_information":[{"code":"80201","type":"CPT"},{"code":"902637","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":11.68,"maximum":38.61,"gross_charge":337.05,"discounted_cash":337.05,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.52,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.80,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.16,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":11.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.68,"methodology":"fee schedule"}]}]},{"description":"Upper extremity addition, harness, chest or shoulder, saddle type ","code_information":[{"code":"L6672","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":232.29,"maximum":248.88,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":237.03,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":237.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":237.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":237.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":237.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":237.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":237.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":237.03,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":237.03,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":248.88,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":237.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":234.66,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":241.77,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":237.03,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":237.03,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":237.03,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":237.03,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":237.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":232.29,"methodology":"fee schedule"}]}]},{"description":"Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each ","code_information":[{"code":"A4358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":8.87,"maximum":9.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":9.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":8.96,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":9.23,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":9.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":8.87,"methodology":"fee schedule"}]}]},{"description":"Walker, folding (pickup), adjustable or fixed height ","code_information":[{"code":"E0135","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":53.26,"maximum":57.07,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":57.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":53.81,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":55.44,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":54.35,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":53.26,"methodology":"fee schedule"}]}]},{"description":"Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, otto bock or equal, switch, cables, two batteries and one charger, switch control of terminal device ","code_information":[{"code":"L6920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":9318.47,"maximum":9984.07,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":9508.64,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":9508.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":9508.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":9508.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":9508.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":9508.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":9508.64,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":9508.64,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":9508.64,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":9984.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":9508.64,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9413.55,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":9698.81,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":9508.64,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":9508.64,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":9508.64,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":9508.64,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":9508.64,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9318.47,"methodology":"fee schedule"}]}]},{"description":"Acylcarnitines; quantitative, each specimen ","code_information":[{"code":"82017","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.35,"maximum":17.71,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.70,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":17.21,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":12.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16.53,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket ","code_information":[{"code":"L5648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1008.34,"maximum":1080.37,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1028.92,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1028.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1028.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1028.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1028.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1028.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1028.92,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1028.92,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1028.92,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1080.37,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1028.92,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1018.63,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1049.50,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1028.92,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1028.92,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1028.92,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1028.92,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1028.92,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1008.34,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, molded inner boot ","code_information":[{"code":"L2280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":488.22,"maximum":523.09,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":498.18,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":498.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":498.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":498.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":498.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":498.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":498.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":498.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":498.18,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":523.09,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":498.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":493.20,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":508.14,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":498.18,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":498.18,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":498.18,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":498.18,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":498.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":488.22,"methodology":"fee schedule"}]}]},{"description":"Addition to terminal device, modifier wrist unit ","code_information":[{"code":"L6805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":409.05,"maximum":438.27,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":417.40,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":417.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":417.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":417.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":417.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":417.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":417.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":417.40,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":417.40,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":438.27,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":417.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":413.23,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":425.75,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":417.40,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":417.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":417.40,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":417.40,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":417.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":409.05,"methodology":"fee schedule"}]}]},{"description":"Addition, endoskeletal system, below knee, flexible protective outer surface covering system ","code_information":[{"code":"L5962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":860.13,"maximum":921.56,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":877.68,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":877.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":877.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":877.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":877.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":877.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":877.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":877.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":877.68,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":921.56,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":877.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":868.90,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":895.23,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":877.68,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":877.68,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":877.68,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":877.68,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":877.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":860.13,"methodology":"fee schedule"}]}]},{"description":"Adhesive, liquid or equal, any type, per oz ","code_information":[{"code":"A4364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3.93,"maximum":4.21,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4.21,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3.97,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4.09,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3.93,"methodology":"fee schedule"}]}]},{"description":"Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf ","code_information":[{"code":"L1902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":86.07,"maximum":92.22,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":92.22,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":86.95,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":89.59,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":86.07,"methodology":"fee schedule"}]}]},{"description":"Water collection device, used with large volume nebulizer ","code_information":[{"code":"A7012","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":3.33,"maximum":3.57,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3.37,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3.47,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3.33,"methodology":"fee schedule"}]}]},{"description":"Whole mitochondrial genome (eg, Leigh syndrome, mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes ºMELAS», myoclonic epilepsy with ragged-red fibers ºMERFF», neuropathy, ataxi ","code_information":[{"code":"81460","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1261.26,"maximum":1709.73,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1287.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1287.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1287.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1287.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1287.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1287.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1287.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1287.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1287.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1351.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1287.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1274.13,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1312.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1287.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1709.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1709.73,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1287.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1640.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1287.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1287.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1287.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1261.26,"methodology":"fee schedule"}]}]},{"description":"Addition to ctlso or scoliosis orthosis, kyphosis pad, floating ","code_information":[{"code":"L1025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":134.45,"maximum":144.05,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":137.19,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":137.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":137.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":137.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":137.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":137.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":137.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":137.19,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":137.19,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":144.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":137.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":135.82,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":139.93,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":137.19,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":137.19,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":137.19,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":137.19,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":137.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":134.45,"methodology":"fee schedule"}]}]},{"description":"Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without ","code_information":[{"code":"L5683","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1539.48,"maximum":1649.45,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1649.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1555.19,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1602.32,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1570.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1539.48,"methodology":"fee schedule"}]}]},{"description":"Addition to tlso, (low profile), lumbar derotation pad ","code_information":[{"code":"L1240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":83.72,"maximum":89.70,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":85.43,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":85.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":85.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":85.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":85.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":85.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":85.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":85.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":85.43,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":89.70,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":85.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":84.58,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":87.14,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":85.43,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":85.43,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":85.43,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":85.43,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":85.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":83.72,"methodology":"fee schedule"}]}]},{"description":"Aldosterone ","code_information":[{"code":"82088","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":39.94,"maximum":97.02,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":42.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":40.34,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":41.56,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":97.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":97.02,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":93.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":40.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":39.94,"methodology":"fee schedule"}]}]},{"description":"Aluminum ","code_information":[{"code":"82108","type":"CPT"},{"code":"902664","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":24.97,"maximum":40.59,"gross_charge":244.60,"discounted_cash":244.60,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":26.75,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":25.23,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":25.99,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":40.59,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":38.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":25.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":24.97,"methodology":"fee schedule"}]}]},{"description":"Anti-reflective coating, per lens ","code_information":[{"code":"V2750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":21.92,"maximum":23.49,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":23.49,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":22.15,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":22.82,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":22.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":21.92,"methodology":"fee schedule"}]}]},{"description":"Antibody; Legionella ","code_information":[{"code":"86713","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.99,"maximum":34.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":16.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":15.15,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":15.61,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":34.65,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":33.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":15.30,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14.99,"methodology":"fee schedule"}]}]},{"description":"Apol1 (apolipoprotein l1) (eg, chronic kidney disease), risk variants ","code_information":[{"code":"0355U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":134.26,"maximum":143.85,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":143.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":135.63,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":139.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":137.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":134.26,"methodology":"fee schedule"}]}]},{"description":"Bed cradle, any type ","code_information":[{"code":"E0280","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":36.59,"maximum":39.21,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":39.21,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":36.97,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":38.09,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":37.34,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":36.59,"methodology":"fee schedule"}]}]},{"description":"Blood glucose monitor with integrated voice synthesizer ","code_information":[{"code":"E2100","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":807.11,"maximum":864.76,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":823.58,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":823.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":823.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":823.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":823.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":823.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":823.58,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":823.58,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":823.58,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":864.76,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":823.58,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":815.34,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":840.05,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":823.58,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":823.58,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":823.58,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":823.58,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":823.58,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":807.11,"methodology":"fee schedule"}]}]},{"description":"Canister, disposable, used with suction pump, each ","code_information":[{"code":"A7000","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":10.12,"maximum":10.85,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":10.85,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":10.23,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":10.54,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10.12,"methodology":"fee schedule"}]}]},{"description":"Cast supplies, long leg cast, pediatric (0-10 years), plaster ","code_information":[{"code":"Q4031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":17.26,"maximum":18.49,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":18.49,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":17.43,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":17.96,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":17.61,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":17.26,"methodology":"fee schedule"}]}]},{"description":"Chloride; blood ","code_information":[{"code":"82435","type":"CPT"},{"code":"902612","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":4.51,"maximum":51.48,"gross_charge":164.05,"discounted_cash":164.05,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":51.48,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":49.40,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.51,"methodology":"fee schedule"}]}]},{"description":"Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing ","code_information":[{"code":"A6203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":4.51,"maximum":4.83,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.55,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4.69,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.51,"methodology":"fee schedule"}]}]},{"description":"Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates ","code_information":[{"code":"87075","type":"CPT"},{"code":"902856","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":9.28,"maximum":26.73,"gross_charge":366.88,"discounted_cash":366.88,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":9.94,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9.38,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":9.66,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":25.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9.28,"methodology":"fee schedule"}]}]},{"description":"Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities; interrogation of genomic regions for copy number variants, comparative genomic hybridization ºCGH» microarray analysis ","code_information":[{"code":"81228","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":462.65,"maximum":945.00,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":945.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":891.00,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":918.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":482.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":482.13,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":462.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":900.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":882.00,"methodology":"fee schedule"}]}]},{"description":"Dynamic adjustable finger extension and flexion device, includes soft interface material ","code_information":[{"code":"E1825","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":143.61,"maximum":153.87,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":153.87,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":145.07,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":149.47,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":146.54,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":143.61,"methodology":"fee schedule"}]}]},{"description":"Epilepsy genomic sequence analysis panel, must include analyses for ALDH7A1, CACNA1A, CDKL5, CHD2, GABRG2, GRIN2A, KCNQ2, MECP2, PCDH19, POLG, PRRT2, SCN1A, SCN1B, SCN2A, SCN8A, SLC2A1, SLC9A6, STXBP1 ","code_information":[{"code":"81419","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1605.50,"maximum":2570.99,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2570.99,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2424.07,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2497.53,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1673.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1673.10,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1605.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2448.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2399.59,"methodology":"fee schedule"}]}]},{"description":"Face tent ","code_information":[{"code":"A4619","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":2.38,"maximum":2.55,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":2.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2.41,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2.48,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2.38,"methodology":"fee schedule"}]}]},{"description":"Fibrinogen; antigen ","code_information":[{"code":"85385","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":14.17,"maximum":27.72,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":15.18,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":14.32,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":14.75,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":27.72,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":26.60,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":14.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":14.17,"methodology":"fee schedule"}]}]},{"description":"Frames, purchases ","code_information":[{"code":"V2020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":84.39,"maximum":90.42,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":90.42,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":85.25,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":87.83,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":86.11,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":84.39,"methodology":"fee schedule"}]}]},{"description":"Gastrin after secretin stimulation ","code_information":[{"code":"82938","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":17.34,"maximum":224.73,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":18.57,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":17.51,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":18.04,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":224.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":224.73,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":215.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":17.69,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":17.34,"methodology":"fee schedule"}]}]},{"description":"Glucose; tolerance test (GTT), 3 specimens (includes glucose) ","code_information":[{"code":"82951","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.61,"maximum":50.49,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.13,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":50.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":50.49,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":48.45,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":12.87,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.61,"methodology":"fee schedule"}]}]},{"description":"Gradient compression stocking, waist length, 30-40 mmhg, custom, each ","code_information":[{"code":"A6563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":940.68,"maximum":1007.87,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1007.87,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":950.28,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":979.08,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":959.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":940.68,"methodology":"fee schedule"}]}]},{"description":"Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome, Pendred syndrome); genomic sequence analysis panel, must include sequencing of at least 60 genes, including CDH23, CLRN1, GJB2, GPR98, MTRN ","code_information":[{"code":"81430","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":1592.50,"maximum":2171.07,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1625.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1625.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1625.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1625.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1625.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1625.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1625.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1625.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1625.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1706.25,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1625.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1608.75,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1657.50,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1625.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2171.07,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2171.07,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1625.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":2083.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1625.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1625.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1625.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1592.50,"methodology":"fee schedule"}]}]},{"description":"Hemoglobin; methemoglobin, quantitative ","code_information":[{"code":"83050","type":"CPT"},{"code":"946880","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":8.04,"maximum":22.77,"gross_charge":539.35,"discounted_cash":539.35,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":8.61,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":8.12,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":8.36,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":22.77,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":21.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":8.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":8.04,"methodology":"fee schedule"}]}]},{"description":"High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 foot pounds at 50% maximum stretch, width greater than or equal to three inches and less than five inche ","code_information":[{"code":"A6452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":7.89,"maximum":8.45,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":8.45,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":7.97,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":8.21,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":8.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":7.89,"methodology":"fee schedule"}]}]},{"description":"HLA Class I typing, high resolution (ie, alleles or allele groups); complete (ie, HLA-A, -B, and -C) ","code_information":[{"code":"81379","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":328.67,"maximum":630.63,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":352.15,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":332.03,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":342.09,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":630.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":630.63,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":605.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":335.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":328.67,"methodology":"fee schedule"}]}]},{"description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, by radioimmunoassay (eg, RIA) ","code_information":[{"code":"83519","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.03,"maximum":64.35,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19.32,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":18.22,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":18.77,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":64.35,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":64.35,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":61.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":18.40,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18.03,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay ºEIA», enzyme-linked immunosorbent assay ºELISA», fluorescence immunoassay ºFIA», immunochemiluminometric assay ºIMC ","code_information":[{"code":"87427","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":11.74,"maximum":62.37,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":12.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":11.86,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.22,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":62.37,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":59.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":11.98,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":11.74,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, quantification ","code_information":[{"code":"87497","type":"CPT"},{"code":"947259","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":41.98,"maximum":152.46,"gross_charge":623.41,"discounted_cash":623.41,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":44.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":42.41,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":152.46,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":152.46,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":146.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":41.98,"methodology":"fee schedule"}]}]},{"description":"Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation ","code_information":[{"code":"A4313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":21.05,"maximum":22.55,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":22.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":21.27,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":21.91,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":21.48,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":21.05,"methodology":"fee schedule"}]}]},{"description":"Iv pole ","code_information":[{"code":"E0776","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":170.21,"maximum":182.36,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":173.68,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":173.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":173.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":173.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":173.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":173.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":173.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":173.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":173.68,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":182.36,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":173.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":171.94,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":177.15,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":173.68,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":173.68,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":173.68,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":173.68,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":173.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":170.21,"methodology":"fee schedule"}]}]},{"description":"Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, pr ","code_information":[{"code":"L1845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":910.17,"maximum":975.19,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":928.75,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":928.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":928.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":928.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":928.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":928.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":928.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":928.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":928.75,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":975.19,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":928.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":919.46,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":947.33,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":928.75,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":928.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":928.75,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":928.75,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":928.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":910.17,"methodology":"fee schedule"}]}]},{"description":"Lenticular lens, per lens, bifocal ","code_information":[{"code":"V2221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":104.65,"maximum":112.13,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":106.79,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":106.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":106.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":106.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":106.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":106.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":106.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":106.79,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":106.79,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":112.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":106.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":105.72,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":108.93,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":106.79,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":106.79,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":106.79,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":106.79,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":106.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":104.65,"methodology":"fee schedule"}]}]},{"description":"Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lat ","code_information":[{"code":"L0637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1209.05,"maximum":1295.41,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1233.72,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1233.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1233.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1233.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1233.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1233.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1233.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1233.72,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1233.72,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1295.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1233.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1221.38,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1258.39,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1233.72,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1233.72,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1233.72,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1233.72,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1233.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1209.05,"methodology":"fee schedule"}]}]},{"description":"Mechanical fragility, RBC, shear stress and spectral analysis profiling ","code_information":[{"code":"0123U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":350.48,"maximum":1022.67,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":375.51,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":354.05,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":364.78,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1022.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1022.67,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":981.35,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":357.63,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":350.48,"methodology":"fee schedule"}]}]},{"description":"Monitor control cable for use with electric ventricular assist device, replacement only ","code_information":[{"code":"Q0485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":411.45,"maximum":440.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":419.85,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":419.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":419.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":419.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":419.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":419.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":419.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":419.85,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":419.85,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":440.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":419.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":415.65,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":428.25,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":419.85,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":419.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":419.85,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":419.85,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":419.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":411.45,"methodology":"fee schedule"}]}]},{"description":"Obstetric panel This panel must include the following: Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated ","code_information":[{"code":"80055","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":37.05,"maximum":50.20,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":50.20,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":47.33,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":48.77,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":38.61,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":37.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":47.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":46.85,"methodology":"fee schedule"}]}]},{"description":"Oncology (high-grade prostate cancer), biochemical assay of four proteins (Total PSA, Free PSA, Intact PSA, and human kallikrein-2 ºhK2»), utilizing plasma or serum, prognostic algorithm reported as a ","code_information":[{"code":"81539","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":744.80,"maximum":20579.13,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":798.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":752.40,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":775.20,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":20579.13,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":20579.13,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":19747.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":760.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":744.80,"methodology":"fee schedule"}]}]},{"description":"Oncology (papillary thyroid cancer), gene-expression profiling via targeted hybrid capture-enrichment rna sequencing of 82 content genes and 10 housekeeping genes, formalin-fixed paraffin embedded (ff ","code_information":[{"code":"0362U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":3528.00,"maximum":3780.00,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3780.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3564.00,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3672.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3600.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3528.00,"methodology":"fee schedule"}]}]},{"description":"Oncology, autophagy and beclin 1 revulator 1 and loricrin by immunohistochemistry, formalinfixed paraffin-embedded tissue, report for risk of progression ","code_information":[{"code":"0387U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":929.53,"maximum":995.93,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":995.93,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":939.01,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":967.47,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":948.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":929.53,"methodology":"fee schedule"}]}]},{"description":"Ostomy irrigation supply; cone/catheter, with or without brush ","code_information":[{"code":"A4399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":16.41,"maximum":17.58,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.58,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.57,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":17.07,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.74,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16.41,"methodology":"fee schedule"}]}]},{"description":"Outflare wedge ","code_information":[{"code":"L3390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":57.83,"maximum":61.96,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":61.96,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":58.42,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":60.19,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":59.01,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":57.83,"methodology":"fee schedule"}]}]},{"description":"Phosphatidylglycerol ","code_information":[{"code":"84081","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.19,"maximum":26.73,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":17.35,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":16.35,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":16.85,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":26.73,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":25.65,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":16.52,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16.19,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, head control interface, contact switch mechanism, nonproportional, including all related electronics, mechanical stop switch, mechanical direction change switch, head array ","code_information":[{"code":"E2329","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":203.55,"maximum":218.09,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":207.70,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":207.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":207.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":207.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":207.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":207.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":207.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":207.70,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":207.70,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":218.09,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":207.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":205.62,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":211.85,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":207.70,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":207.70,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":207.70,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":207.70,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":207.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":203.55,"methodology":"fee schedule"}]}]},{"description":"Prosthetic sock, single ply, fitting, below knee, each ","code_information":[{"code":"L8470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":10.22,"maximum":10.95,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":10.95,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":10.33,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":10.64,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":10.43,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10.22,"methodology":"fee schedule"}]}]},{"description":"Red cell antigen (Dombrock blood group) genotyping (DO), gene analysis ART4 (ADP-ribosyltransferase 4) exon 2 ","code_information":[{"code":"0184U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":181.50,"maximum":529.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":194.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":183.35,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":529.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":529.65,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":508.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":181.50,"methodology":"fee schedule"}]}]},{"description":"RHD & RHCE Gnotyp Next-Genrj Seq RH Prox Promoter ","code_information":[{"code":"0222U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":277.22,"maximum":808.83,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":297.02,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":280.05,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":288.54,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":808.83,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":808.83,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":776.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":282.88,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":277.22,"methodology":"fee schedule"}]}]},{"description":"Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batte ","code_information":[{"code":"L6965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":19988.57,"maximum":21416.33,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":20396.50,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":20396.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20396.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20396.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20396.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20396.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20396.50,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20396.50,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":20396.50,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":21416.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":20396.50,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":20192.53,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":20804.43,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":20396.50,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":20396.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":20396.50,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":20396.50,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":20396.50,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19988.57,"methodology":"fee schedule"}]}]},{"description":"Sling or seat, patient lift, canvas or nylon ","code_information":[{"code":"E0621","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":95.42,"maximum":102.24,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":102.24,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":96.40,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":99.32,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":97.37,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":95.42,"methodology":"fee schedule"}]}]},{"description":"Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens ","code_information":[{"code":"V2104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":55.13,"maximum":59.07,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":59.07,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":55.70,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":57.39,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":56.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":55.13,"methodology":"fee schedule"}]}]},{"description":"Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs  separately) ","code_information":[{"code":"A4221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":23.97,"maximum":25.68,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":25.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":24.22,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":24.95,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":24.46,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":23.97,"methodology":"fee schedule"}]}]},{"description":"Thyrotropin releasing hormone (TRH) stimulation panel; 1 hour This panel must include the following: Thyroid stimulating hormone (TSH) (84443 x 3) ","code_information":[{"code":"80438","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":49.40,"maximum":473.22,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":52.93,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":49.91,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":51.42,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":473.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":473.22,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":454.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":50.41,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":49.40,"methodology":"fee schedule"}]}]},{"description":"Tracheoesophageal puncture dilator, replacement only, each ","code_information":[{"code":"L8514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":110.14,"maximum":118.01,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":112.39,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":112.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":112.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":112.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":112.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":112.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":112.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":112.39,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":112.39,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":118.01,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":112.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":111.27,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":114.64,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":112.39,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":112.39,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":112.39,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":112.39,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":112.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":110.14,"methodology":"fee schedule"}]}]},{"description":"Transferase; aspartate amino (AST) (SGOT) ","code_information":[{"code":"84450","type":"CPT"},{"code":"902492","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":5.08,"maximum":47.52,"gross_charge":238.61,"discounted_cash":238.61,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.44,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.13,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.28,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":47.52,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":47.52,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":45.60,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.18,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.08,"methodology":"fee schedule"}]}]},{"description":"Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow ","code_information":[{"code":"L6677","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":346.49,"maximum":371.24,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":353.56,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":353.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":353.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":353.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":353.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":353.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":353.56,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":353.56,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":353.56,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":371.24,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":353.56,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":350.02,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":360.63,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":353.56,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":353.56,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":353.56,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":353.56,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":353.56,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":346.49,"methodology":"fee schedule"}]}]},{"description":"Urinary suspensory with leg bag, with or without tube, each ","code_information":[{"code":"A5105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":48.23,"maximum":51.67,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":51.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":48.72,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":50.19,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":49.21,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":48.23,"methodology":"fee schedule"}]}]},{"description":"Water pressure pad for mattress, standard mattress length and width ","code_information":[{"code":"E0198","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":29.64,"maximum":31.75,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":31.75,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":29.94,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":30.84,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":30.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":29.64,"methodology":"fee schedule"}]}]},{"description":"Wheelchair, pediatric size, tilt-in-space, folding, adjustable, with seating system ","code_information":[{"code":"E1232","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":285.96,"maximum":306.39,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":291.80,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":291.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":291.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":291.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":291.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":291.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":291.80,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":291.80,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":291.80,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":306.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":291.80,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":288.88,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":297.64,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":291.80,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":291.80,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":291.80,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":291.80,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":291.80,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":285.96,"methodology":"fee schedule"}]}]},{"description":"Potassium; urine ","code_information":[{"code":"84133","type":"CPT"},{"code":"902579","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":4.64,"maximum":37.62,"gross_charge":220.72,"discounted_cash":220.72,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":4.97,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.68,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4.82,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":37.62,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":37.62,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":36.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.73,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.64,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only ","code_information":[{"code":"E2375","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":75.27,"maximum":80.65,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":76.81,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":76.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":76.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":76.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":76.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":76.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":76.81,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":76.81,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":76.81,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":80.65,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":76.81,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":76.04,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":78.35,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":76.81,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":76.81,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":76.81,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":76.81,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":76.81,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":75.27,"methodology":"fee schedule"}]}]},{"description":"Preparatory, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, sach foot, prefabricated adjustable open end socket ","code_information":[{"code":"L5585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3324.51,"maximum":3561.98,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3392.36,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3392.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3392.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3392.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3392.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3392.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3392.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3392.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3392.36,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3561.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3392.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3358.44,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3460.21,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3392.36,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3392.36,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3392.36,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3392.36,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3392.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3324.51,"methodology":"fee schedule"}]}]},{"description":"Protein analysis of tissue by Western Blot, with interpretation and report; immunological probe for band identification, each ","code_information":[{"code":"88372","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":25.70,"maximum":499.95,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":27.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":25.96,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":26.74,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":479.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":26.22,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":25.70,"methodology":"fee schedule"}]}]},{"description":"Replace molded calf lacer, for custom fabricated orthosis only ","code_information":[{"code":"L4050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":445.12,"maximum":476.91,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":454.20,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":454.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":454.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":454.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":454.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":454.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":454.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":454.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":454.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":476.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":454.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":449.66,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":463.28,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":454.20,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":454.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":454.20,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":454.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":454.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":445.12,"methodology":"fee schedule"}]}]},{"description":"Rheumatoid factor; quantitative ","code_information":[{"code":"86431","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.56,"maximum":61.38,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.95,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.61,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.78,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":61.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":61.38,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":58.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.56,"methodology":"fee schedule"}]}]},{"description":"SERPINA1 (serpin peptidase inhibitor, clade A, alpha-1 antiproteinase, antitrypsin, member 1) (eg, alpha-1-antitrypsin deficiency), gene analysis, common variants (eg, *S and *Z) ","code_information":[{"code":"81332","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":42.78,"maximum":499.95,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":45.83,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":43.21,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":44.52,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":499.95,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":479.75,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":43.65,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":42.78,"methodology":"fee schedule"}]}]},{"description":"Skin protection and positioning wheelchair seat cushion, adjustable, width 22 inches or greater, any depth ","code_information":[{"code":"E2625","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":452.93,"maximum":485.28,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":462.17,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":462.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":462.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":462.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":462.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":462.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":462.17,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":462.17,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":462.17,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":485.28,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":462.17,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":457.55,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":471.41,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":462.17,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":462.17,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":462.17,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":462.17,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":462.17,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":452.93,"methodology":"fee schedule"}]}]},{"description":"Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit test ","code_information":[{"code":"89330","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":10.17,"maximum":33.66,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":10.90,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":10.28,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":10.59,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":33.66,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":32.30,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":10.38,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":10.17,"methodology":"fee schedule"}]}]},{"description":"Spherocylinder, single vision, sphere over plus or minus 12.00d, per lens ","code_information":[{"code":"V2114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":95.86,"maximum":102.71,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":97.82,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":97.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":97.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":97.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":97.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":97.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":97.82,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":97.82,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":97.82,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":102.71,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":97.82,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":96.84,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":99.78,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":97.82,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":97.82,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":97.82,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":97.82,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":97.82,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":95.86,"methodology":"fee schedule"}]}]},{"description":"Sulfate, urine ","code_information":[{"code":"84392","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":5.38,"maximum":14.85,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.76,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.44,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.60,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":14.85,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":14.25,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.49,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":5.38,"methodology":"fee schedule"}]}]},{"description":"Tlso, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior ex ","code_information":[{"code":"L0462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1455.54,"maximum":1559.50,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1485.24,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1485.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1485.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1485.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1485.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1485.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1485.24,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1485.24,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1485.24,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1559.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1485.24,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1470.39,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1514.94,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1485.24,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1485.24,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1485.24,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1485.24,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1485.24,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1455.54,"methodology":"fee schedule"}]}]},{"description":"Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement ","code_information":[{"code":"L8618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":30.68,"maximum":32.88,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":32.88,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":31.00,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":31.94,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":31.31,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":30.68,"methodology":"fee schedule"}]}]},{"description":"Twelve volt battery, each ","code_information":[{"code":"L7364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":457.72,"maximum":490.41,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":467.06,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":467.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":467.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":467.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":467.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":467.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":467.06,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":467.06,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":467.06,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":490.41,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":467.06,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":462.39,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":476.40,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":467.06,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":467.06,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":467.06,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":467.06,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":467.06,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":457.72,"methodology":"fee schedule"}]}]},{"description":"Upper extremity addition, rotation wrist unit with cable lock ","code_information":[{"code":"L6625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":610.92,"maximum":654.56,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":623.39,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":623.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":623.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":623.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":623.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":623.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":623.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":623.39,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":623.39,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":654.56,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":623.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":617.16,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":635.86,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":623.39,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":623.39,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":623.39,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":623.39,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":623.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":610.92,"methodology":"fee schedule"}]}]},{"description":"Very long chain acyl-coenzyme A (CoA) dehydrogenase (VLCAD), leukocyte enzyme activity, whole blood ","code_information":[{"code":"0257U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":698.22,"maximum":748.09,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":748.09,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":705.35,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":726.72,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":712.47,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":698.22,"methodology":"fee schedule"}]}]},{"description":"Whole mitochondrial genome large deletion analysis panel (eg, Kearns-Sayre syndrome, chronic progressive external ophthalmoplegia), including heteroplasmy detection, if performed ","code_information":[{"code":"81465","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":917.28,"maximum":1673.10,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":982.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":926.64,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":954.72,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1673.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1673.10,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1605.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":936.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":917.28,"methodology":"fee schedule"}]}]},{"description":"Hospital bed, variable height, hi-lo, without side rails, without mattress ","code_information":[{"code":"E0293","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":67.30,"maximum":72.10,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":72.10,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":67.98,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":70.04,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":68.67,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":67.30,"methodology":"fee schedule"}]}]},{"description":"Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified ","code_information":[{"code":"83520","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":16.92,"maximum":69.30,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":18.13,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":17.10,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":17.62,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":69.30,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":69.30,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":66.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":17.27,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":16.92,"methodology":"fee schedule"}]}]},{"description":"Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay ºEIA», enzyme-linked immunosorbent assay ºELISA», fluorescence immunoassay ºFIA», immunochemiluminometric assay ºIMC ","code_information":[{"code":"115059","type":"CDM"},{"code":"87428","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":38.00,"maximum":73.80,"gross_charge":124.30,"discounted_cash":124.30,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":73.80,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":69.59,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":71.70,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":39.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":39.60,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":38.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":70.29,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":68.88,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi, amplified probe technique ","code_information":[{"code":"87476","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":28.50,"maximum":36.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":36.84,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":34.74,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":35.79,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":29.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":29.70,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":28.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":35.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":34.39,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, direct probe technique ","code_information":[{"code":"87528","type":"CPT"},{"code":"947263","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":19.65,"maximum":121.77,"gross_charge":813.49,"discounted_cash":813.49,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":21.05,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":19.85,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":20.45,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":121.77,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":121.77,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":116.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":20.05,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":19.65,"methodology":"fee schedule"}]}]},{"description":"Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, quantification ","code_information":[{"code":"87557","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":41.98,"maximum":137.61,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":44.98,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":42.41,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":43.70,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":137.61,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":137.61,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":132.05,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":42.84,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":41.98,"methodology":"fee schedule"}]}]},{"description":"Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.) ","code_information":[{"code":"E0783","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU|KF","modifiers_description":"New equipment|Item designated by FDA as Class III device","setting":"outpatient","minimum":9305.10,"maximum":9969.75,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":9495.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":9495.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":9495.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":9495.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":9495.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":9495.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":9495.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":9495.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":9495.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":9969.75,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":9495.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":9400.05,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":9684.90,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":9495.00,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":9495.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":9495.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":9495.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":9495.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":9305.10,"methodology":"fee schedule"}]}]},{"description":"JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) targeted sequence analysis (eg, exons 12 and 13) ","code_information":[{"code":"81279","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":181.50,"maximum":552.42,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":194.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":183.35,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":188.90,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":552.42,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":552.42,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":530.10,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":185.20,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":181.50,"methodology":"fee schedule"}]}]},{"description":"Lenticular, (myodisc), per lens, single vision ","code_information":[{"code":"V2115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":101.29,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":108.53,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":102.33,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":105.43,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":103.36,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":101.29,"methodology":"fee schedule"}]}]},{"description":"Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on th ","code_information":[{"code":"L0648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":485.00,"maximum":519.64,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":494.90,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":494.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":494.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":494.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":494.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":494.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":494.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":494.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":494.90,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":519.64,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":494.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":489.95,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":504.80,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":494.90,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":494.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":494.90,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":494.90,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":494.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":485.00,"methodology":"fee schedule"}]}]},{"description":"Meat fibers, feces ","code_information":[{"code":"89160","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":4.75,"maximum":15.84,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":4.80,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":4.95,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":15.84,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":15.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":4.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.75,"methodology":"fee schedule"}]}]},{"description":"Muramidase ","code_information":[{"code":"85549","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":18.38,"maximum":36.63,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19.69,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":18.56,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":19.13,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":36.63,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":35.15,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":18.75,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18.38,"methodology":"fee schedule"}]}]},{"description":"Non-pneumatic sequential compression garment, trunk ","code_information":[{"code":"E0677","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":77.27,"maximum":82.79,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":82.79,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":78.06,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":80.43,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":78.85,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":77.27,"methodology":"fee schedule"}]}]},{"description":"Oncology (cutaneous squamous cell carcinoma), mRNA gene expression profiling by RT-PCR of 40 genes (34 content and 6 housekeeping), utilizing formalin-fixed paraffin-embedded (FFPE) tissue, algorithm ","code_information":[{"code":"0315U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":8330.00,"maximum":8925.00,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":8500.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":8500.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":8500.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":8500.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":8500.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":8500.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":8500.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":8500.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":8500.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":8925.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":8500.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":8415.00,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":8670.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":8500.00,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":8500.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":8500.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":8500.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":8500.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":8330.00,"methodology":"fee schedule"}]}]},{"description":"Oncology (solid tumor as indicated by the label), somatic mutation analyis of BRCA1, BRCA2 and analysis of homologous recombination deficiency pathways, DNA, formalin-fixed paraffin-embedded tissue, a ","code_information":[{"code":"0172U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2969.40,"maximum":8668.44,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3030.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3030.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3030.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3030.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3030.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3030.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3030.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3030.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3030.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3181.50,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3030.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2999.70,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3090.60,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3030.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8668.44,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8668.44,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3030.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8318.20,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3030.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3030.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3030.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2969.40,"methodology":"fee schedule"}]}]},{"description":"Orthopedic shoe addition, toe tap, horseshoe ","code_information":[{"code":"L3560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":26.65,"maximum":28.55,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":28.55,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":26.92,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":27.73,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":27.19,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":26.65,"methodology":"fee schedule"}]}]},{"description":"Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each ","code_information":[{"code":"A4426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3.65,"maximum":3.91,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3.68,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3.79,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3.65,"methodology":"fee schedule"}]}]},{"description":"Ovulation tests, by visual color comparison methods for human luteinizing hormone ","code_information":[{"code":"84830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":12.45,"maximum":59.40,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.33,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12.57,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":12.95,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":59.40,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":59.40,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":57.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":12.70,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.45,"methodology":"fee schedule"}]}]},{"description":"Peanut allergen-specific IgE and quantitative assessment of 64 epitopes using enzyme-linked immunosorbent assay (ELISA), blood, individual epitope results and interpretation ","code_information":[{"code":"0165U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":454.48,"maximum":1326.60,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":486.95,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":459.12,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":473.04,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1326.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1326.60,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1273.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":463.76,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":454.48,"methodology":"fee schedule"}]}]},{"description":"Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing ","code_information":[{"code":"E0431","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":21.25,"maximum":22.76,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":22.76,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":21.46,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":22.11,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":21.68,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":21.25,"methodology":"fee schedule"}]}]},{"description":"Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) ","code_information":[{"code":"E2365","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":86.49,"maximum":92.67,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":92.67,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":87.38,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":90.03,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":88.26,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":86.49,"methodology":"fee schedule"}]}]},{"description":"Preparatory, above knee - knee disarticulation ischial level socket, non-alignable system, pylon no cover, sach foot, laminated socket, molded to model ","code_information":[{"code":"L5590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":3526.56,"maximum":3778.46,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":3598.53,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":3598.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":3598.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":3598.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":3598.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":3598.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":3598.53,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":3598.53,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":3598.53,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3778.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":3598.53,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":3562.54,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":3670.50,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":3598.53,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":3598.53,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":3598.53,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":3598.53,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":3598.53,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":3526.56,"methodology":"fee schedule"}]}]},{"description":"Prosthetic sock, multiple ply, above knee, each ","code_information":[{"code":"L8430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":28.21,"maximum":30.23,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":30.23,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":28.50,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":29.37,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":28.79,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":28.21,"methodology":"fee schedule"}]}]},{"description":"Red blood cell antigen typing, DNA, genotyping of 12 blood group system genes to predict 44 red blood cell antigen phenotypes ","code_information":[{"code":"0282U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":705.60,"maximum":2059.20,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":756.00,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":712.80,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":734.40,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":2059.20,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":2059.20,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1976.00,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":720.00,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":705.60,"methodology":"fee schedule"}]}]},{"description":"Replacement battery for external infusion pump owned by patient, lithium, 1.5 volt, each ","code_information":[{"code":"A4602","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":4.99,"maximum":5.34,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":5.34,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":5.04,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":5.19,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":5.09,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":4.99,"methodology":"fee schedule"}]}]},{"description":"Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard ","code_information":[{"code":"A6454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":1.05,"maximum":1.12,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":1.12,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":1.06,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":1.09,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":1.07,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":1.05,"methodology":"fee schedule"}]}]},{"description":"Shower cover for use with electric or electric/pneumatic ventricular assist device, replacement only ","code_information":[{"code":"Q0501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":597.70,"maximum":640.39,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":609.90,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":609.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":609.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":609.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":609.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":609.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":609.90,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":609.90,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":609.90,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":640.39,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":609.90,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":603.80,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":622.10,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":609.90,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":609.90,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":609.90,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":609.90,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":609.90,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":597.70,"methodology":"fee schedule"}]}]},{"description":"Solid organ neoplasm, genomic sequence analysis panel, 5-50 genes, interrogation for sequence variants and copy number variants or rearrangements, if performed; DNA analysis or combined DNA and RNA an ","code_information":[{"code":"81445","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":585.95,"maximum":1673.10,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":627.81,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":591.93,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":609.87,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1673.10,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1673.10,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1605.50,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":597.91,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":585.95,"methodology":"fee schedule"}]}]},{"description":"Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens ","code_information":[{"code":"V2107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":53.63,"maximum":57.46,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":57.46,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":54.17,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":55.81,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":54.72,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":53.63,"methodology":"fee schedule"}]}]},{"description":"Targeted genomic sequence analysis panel, acute myelogenous leukemia, DNA analysis, 194 genes, interrogation for sequence variants, copy number variants or rearrangements ","code_information":[{"code":"0050U","type":"CPT"}],"standard_charges":[{"setting":"outpatient","minimum":2858.27,"maximum":8343.72,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":2916.60,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":2916.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":2916.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":2916.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":2916.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":2916.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":2916.60,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":2916.60,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":2916.60,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":3062.43,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":2916.60,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":2887.43,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":2974.93,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":2916.60,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":8343.72,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":8343.72,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":2916.60,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":8006.60,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":2916.60,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":2916.60,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":2916.60,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":2858.27,"methodology":"fee schedule"}]}]},{"description":"Thyroxine; free ","code_information":[{"code":"84439","type":"CPT"},{"code":"902694","type":"CDM"}],"standard_charges":[{"setting":"outpatient","minimum":8.84,"maximum":99.99,"gross_charge":205.80,"discounted_cash":205.80,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":9.47,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":8.93,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":9.20,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":99.99,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":95.95,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":9.02,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":8.84,"methodology":"fee schedule"}]}]},{"description":"Toe loop/holder, any type, each ","code_information":[{"code":"E0952","type":"HCPCS"}],"standard_charges":[{"modifiers":"NU","modifiers_description":"New equipment","setting":"outpatient","minimum":18.45,"maximum":19.77,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":19.77,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":18.64,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":19.21,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":18.83,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":18.45,"methodology":"fee schedule"}]}]},{"description":"Trapeze bars, a/k/a patient helper, attached to bed, with grab bar ","code_information":[{"code":"E0910","type":"HCPCS"}],"standard_charges":[{"modifiers":"RR","modifiers_description":"Rental (use the RR modifier when DME is to be rented)","setting":"outpatient","minimum":12.77,"maximum":13.68,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":13.68,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":12.90,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":13.29,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":13.03,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":12.77,"methodology":"fee schedule"}]}]},{"description":"Upper extremity addition, nudge control elbow lock ","code_information":[{"code":"L6637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","minimum":421.78,"maximum":451.91,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"Anthem BCBS","plan_name":"MCR","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"DualEligible","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRHMO","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPOS","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRPPO","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"MCRSNP","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"Bright Health","plan_name":"PFFS","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"Cigna HealthSpring","plan_name":"Medicare","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"Delaware Life Insurance","plan_name":"MGMCR","standard_charge_dollar":451.91,"methodology":"fee schedule"},{"payer_name":"Devoted Health","plan_name":"MCRAdvantage","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"Humana","plan_name":"MCR","standard_charge_dollar":426.09,"methodology":"fee schedule"},{"payer_name":"InnovAge Pace","plan_name":"MCR","standard_charge_dollar":439.00,"methodology":"fee schedule"},{"payer_name":"Kaiser MCR","plan_name":"MedicareMembersandMedicarePPOInsureds","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"Mutual of Omaha","plan_name":"MCR","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"Rocky Mountain Health","plan_name":"MGMCR","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"Total LongTerm Care","plan_name":"MCR","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_dollar":430.39,"methodology":"fee schedule"},{"payer_name":"United","plan_name":"MCR","standard_charge_dollar":421.78,"methodology":"fee schedule"}]}]},{"description":"SP ANGIO EXT UNI RT ","code_information":[{"code":"75710","type":"CPT"},{"code":"905107","type":"CDM"}],"standard_charges":[{"modifiers":"RT","modifiers_description":"Right side (Used to identify procedures performed on the right side of the body)","setting":"outpatient","gross_charge":5106.65,"discounted_cash":5106.65,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":2752.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1531.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":2257.14,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1889.46,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":3472.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1889.46,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":3063.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":2435.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1618.81,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1705.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1440.08,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":2921.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4595.98,"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":4340.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":3574.66,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2042.66,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4595.98,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4085.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2297.99,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1108.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":919.20,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":3319.32,"methodology":"percent of total billed charges"}]}]},{"description":"SP GRAV BDY FLUID NOT UR ","code_information":[{"code":"84315","type":"CPT"},{"code":"918291","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":37.95,"discounted_cash":37.95,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":20.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":16.77,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":14.04,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":25.81,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":14.04,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":22.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":18.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":12.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":12.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":10.70,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":21.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34.16,"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":32.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":26.57,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":15.18,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34.16,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":8.24,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.83,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":24.67,"methodology":"percent of total billed charges"}]}]},{"description":"SP VENOCAVAGM SUP ","code_information":[{"code":"75827","type":"CPT"},{"code":"948551","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3541.07,"discounted_cash":3541.07,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1908.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1062.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1565.15,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1310.20,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2407.93,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1310.20,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":2124.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1689.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1122.52,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1182.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":998.58,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":2025.49,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3186.96,"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":3009.91,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2478.75,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1416.43,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3186.96,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2832.86,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1593.48,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":768.41,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":637.39,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2301.70,"methodology":"percent of total billed charges"}]}]},{"description":"SPEC GRAV UR MANUAL ","code_information":[{"code":"81002","type":"CPT"},{"code":"946817","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":53.71,"discounted_cash":53.71,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":28.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":23.74,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":19.87,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":36.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":19.87,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":32.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":25.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":17.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":17.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":15.15,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":30.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":48.34,"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":45.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":37.60,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":21.48,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":48.34,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":24.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":11.66,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":9.67,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":34.91,"methodology":"percent of total billed charges"}]}]},{"description":"SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS ","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":42179.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":42179.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":35300.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"SPIRONOLACTONE 100MG TAB ","code_information":[{"code":"908204","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":17.68,"discounted_cash":17.68,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":9.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.81,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.02,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":10.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":8.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.99,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"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":15.03,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":12.38,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":13.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":14.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.84,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.18,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":11.49,"methodology":"percent of total billed charges"}]}]},{"description":"STATLOCK PICC LN LXT FR+ ","code_information":[{"code":"983667","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":34.11,"discounted_cash":34.11,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":18.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":10.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":15.08,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":23.19,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":20.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":16.27,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":10.81,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":11.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":9.62,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":19.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":30.70,"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":28.99,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":23.88,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":13.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":25.58,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":30.70,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":27.29,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":15.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":7.40,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.14,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":22.17,"methodology":"percent of total billed charges"}]}]},{"description":"STAVUDINE 40MG CAP ","code_information":[{"code":"910756","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":56.66,"discounted_cash":56.66,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":30.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":17.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":25.04,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":38.53,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":34.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":27.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":17.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":18.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":15.98,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":32.41,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":50.99,"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":48.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":39.66,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":22.66,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":42.49,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":50.99,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":45.33,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":25.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":12.30,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":10.20,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":36.83,"methodology":"percent of total billed charges"}]}]},{"description":"SUCRALFATE 1GM TAB ","code_information":[{"code":"908383","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"SUT VICRYL 3-0 J416 ","code_information":[{"code":"922457","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":8.95,"discounted_cash":8.95,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":4.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":3.96,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":6.09,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":5.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":4.27,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2.84,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2.52,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":5.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8.05,"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":7.61,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":6.26,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":3.58,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":6.71,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8.05,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7.16,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1.94,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1.61,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":5.82,"methodology":"percent of total billed charges"}]}]},{"description":"T4 FREE ","code_information":[{"code":"84439","type":"CPT"},{"code":"902694","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":205.80,"discounted_cash":205.80,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":110.93,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":90.96,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":76.15,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":139.94,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":76.15,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":123.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":98.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":65.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":68.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":58.04,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":117.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":185.22,"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":174.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":144.06,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":82.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":185.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":92.61,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":44.66,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":37.04,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":133.77,"methodology":"percent of total billed charges"}]}]},{"description":"TC99M MEDRONATE DX 30MCI ","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"903816","type":"CDM"},{"code":"A9503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":259.25,"discounted_cash":259.25,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":77.78,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":95.92,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":176.29,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":95.92,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":155.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":123.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":82.18,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":86.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":73.11,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":148.29,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":233.32,"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":220.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":181.47,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":103.70,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":194.44,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":233.32,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":207.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":116.66,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":56.26,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":46.66,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":168.51,"methodology":"percent of total billed charges"}]}]},{"description":"TEMOZOLOMIDE 100 MG PO ","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"950936","type":"CDM"},{"code":"J8700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":1187.88,"discounted_cash":1187.88,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":640.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":356.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":525.04,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":439.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":807.76,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":439.52,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":712.73,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":566.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":376.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":396.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":334.98,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":679.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1069.09,"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":1009.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":831.52,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":475.15,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":890.91,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1069.09,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":950.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":534.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":257.77,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":213.82,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":772.12,"methodology":"percent of total billed charges"}]}]},{"description":"TESTOSTERONE FREE ","code_information":[{"code":"84402","type":"CPT"},{"code":"902702","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":727.80,"discounted_cash":727.80,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":392.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":321.69,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":269.29,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":494.90,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":269.29,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":436.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":347.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":230.71,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":243.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":205.24,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":416.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":655.02,"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":618.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":509.46,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":291.12,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":655.02,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":327.51,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":157.93,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":131.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":473.07,"methodology":"percent of total billed charges"}]}]},{"description":"THEOPHYLLIN 100MG CRTAB ","code_information":[{"code":"909115","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"THEOPHYLLIN 450MG CRTAB ","code_information":[{"code":"909118","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC ","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"TICAR-CLAV 3.1GM VIAL ","code_information":[{"code":"906762","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":265.28,"discounted_cash":265.28,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":142.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":79.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":117.25,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":180.39,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":159.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":126.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":84.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":88.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":74.81,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":151.74,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":238.75,"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":225.49,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":185.70,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":106.11,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":198.96,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":238.75,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":212.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":119.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":57.57,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":47.75,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":172.43,"methodology":"percent of total billed charges"}]}]},{"description":"TOBRA VANCO SMALL BEADS ","code_information":[{"code":"949124","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":348.00,"discounted_cash":348.00,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":187.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":104.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":153.82,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":236.64,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":208.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":166.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":110.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":116.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":98.14,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":199.06,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":313.20,"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":295.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":243.60,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":139.20,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":261.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":313.20,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":278.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":156.60,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":75.52,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":62.64,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":226.20,"methodology":"percent of total billed charges"}]}]},{"description":"TOBRAMYCIN QUANT ","code_information":[{"code":"80200","type":"CPT"},{"code":"903229","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":414.63,"discounted_cash":414.63,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":223.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":183.27,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":153.41,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":281.95,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":153.41,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":248.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":197.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":131.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":138.49,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":116.93,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":237.17,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":373.17,"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":352.44,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":290.24,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":165.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":373.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":186.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":89.97,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":74.63,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":269.51,"methodology":"percent of total billed charges"}]}]},{"description":"TOTAL PROTEIN URINE QN ","code_information":[{"code":"84156","type":"CPT"},{"code":"902473","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":134.24,"discounted_cash":134.24,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":72.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":59.33,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":49.67,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":91.28,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":49.67,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":80.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":64.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":42.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":44.84,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":37.86,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":76.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":120.82,"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":114.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":93.97,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":53.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":120.82,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":60.41,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":29.13,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":24.16,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":87.26,"methodology":"percent of total billed charges"}]}]},{"description":"TPN CHARGE ","code_information":[{"code":"907941","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":775.21,"discounted_cash":775.21,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":417.84,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":232.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":342.64,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":527.14,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":465.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":369.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":245.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":258.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":218.61,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":443.42,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":697.69,"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":658.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":542.65,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":310.08,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":581.41,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":697.69,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":620.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":348.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":168.22,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":139.54,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":503.89,"methodology":"percent of total billed charges"}]}]},{"description":"TRANS DRN CATH PERT/RETR ","code_information":[{"code":"995141","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":8125.07,"discounted_cash":8125.07,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":4379.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2437.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":3591.28,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":3006.28,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":5525.05,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":3006.28,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4875.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":3875.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2575.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2713.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2291.27,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":4647.54,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7312.56,"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":6906.31,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":5687.55,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":3250.03,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":6093.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7312.56,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":6500.06,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3656.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1763.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1462.51,"methodology":"percent of total billed charges"}]}]},{"description":"TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC ","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"TRIAM ACET .1% CRM 454GM ","code_information":[{"code":"918383","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":118.05,"discounted_cash":118.05,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":63.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":35.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":52.18,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":80.27,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":70.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":56.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":37.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":39.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":33.29,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":67.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":106.25,"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":100.34,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":82.64,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":47.22,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":88.54,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":106.25,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":94.44,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":53.12,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":25.62,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":21.25,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":76.73,"methodology":"percent of total billed charges"}]}]},{"description":"TRIGLYCERIDES ","code_information":[{"code":"84478","type":"CPT"},{"code":"902469","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":220.72,"discounted_cash":220.72,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":118.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":97.56,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":81.67,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":150.09,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":81.67,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":132.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":105.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":69.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":73.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":62.24,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":126.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":198.65,"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":187.61,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":154.50,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":88.29,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":198.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":99.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":47.90,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":39.73,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":143.47,"methodology":"percent of total billed charges"}]}]},{"description":"TROPICAMIDE 1% 2ML ","code_information":[{"code":"926614","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":169.65,"discounted_cash":169.65,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":91.44,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":50.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":74.99,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":115.36,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":101.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":80.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":53.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":56.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":47.84,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":97.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":152.69,"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":144.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":118.75,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":67.86,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":127.24,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":152.69,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":135.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":76.34,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":36.81,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":30.54,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":110.27,"methodology":"percent of total billed charges"}]}]},{"description":"COMP METABOLIC PANEL ","code_information":[{"code":"80053","type":"CPT"},{"code":"902608","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1176.54,"discounted_cash":1176.54,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":634.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":520.03,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":435.32,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":800.05,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":435.32,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":705.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":561.21,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":372.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":392.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":331.78,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":672.98,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1058.89,"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":1000.06,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":823.58,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":470.62,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1058.89,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":529.44,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":255.31,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":211.78,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":764.75,"methodology":"percent of total billed charges"}]}]},{"description":"CONCUSSION WITH MCC ","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC ","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":35833.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":35833.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":29992.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE ","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"CORTISOL TOTAL BASELINE ","code_information":[{"code":"82533","type":"CPT"},{"code":"948236","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":354.96,"discounted_cash":354.96,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":191.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":156.89,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":131.34,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":241.37,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":131.34,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":212.98,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":169.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":112.52,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":118.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":100.10,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":203.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":319.46,"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":301.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":248.47,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":141.98,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":319.46,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":159.73,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":77.03,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":63.89,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":230.72,"methodology":"percent of total billed charges"}]}]},{"description":"COXSACKIE A16 AB QUAL ","code_information":[{"code":"86658","type":"CPT"},{"code":"947108","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":697.99,"discounted_cash":697.99,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":376.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":308.51,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":258.26,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":474.63,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":258.26,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":418.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":332.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":221.26,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":233.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":196.83,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":399.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":628.19,"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":593.29,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":488.59,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":279.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":628.19,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":314.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":151.46,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":125.64,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":453.69,"methodology":"percent of total billed charges"}]}]},{"description":"CRYOFIBRINOGEN ","code_information":[{"code":"82585","type":"CPT"},{"code":"946855","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":676.23,"discounted_cash":676.23,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":364.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":298.89,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":250.21,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":459.84,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":250.21,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":405.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":322.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":214.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":225.86,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":190.70,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":386.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":608.61,"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":574.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":473.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":270.49,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":608.61,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":304.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":146.74,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":121.72,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":439.55,"methodology":"percent of total billed charges"}]}]},{"description":"CT ABDOMEN W&WO CONT ","code_information":[{"code":"74170","type":"CPT"},{"code":"905513","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7275.17,"discounted_cash":7275.17,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":3921.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2182.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":3215.63,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2691.81,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":4947.12,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2691.81,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4365.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":3470.26,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2306.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2429.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2051.60,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":4161.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6547.65,"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":6183.89,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":5092.62,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2910.07,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6547.65,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5820.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3273.83,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1578.71,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1309.53,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":4728.86,"methodology":"percent of total billed charges"}]}]},{"description":"CT GUID NDL PLCMT ","code_information":[{"code":"77012","type":"CPT"},{"code":"992820","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3104.75,"discounted_cash":3104.75,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1673.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":931.42,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1372.30,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1148.76,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2111.23,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1148.76,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1862.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1480.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":984.21,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1036.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":875.54,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1775.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2794.28,"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":2639.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2173.32,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1241.90,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2328.56,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2794.28,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2483.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1397.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":673.73,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":558.86,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2018.09,"methodology":"percent of total billed charges"}]}]},{"description":"CT L-SPINE W/O CONTRAST ","code_information":[{"code":"72131","type":"CPT"},{"code":"905529","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3871.67,"discounted_cash":3871.67,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":2086.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1161.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1711.28,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1432.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2632.74,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1432.52,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":2323.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1846.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1227.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1293.14,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1091.81,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":2214.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3484.50,"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":3290.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2710.17,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1548.67,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3484.50,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3097.34,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1742.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":840.15,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":696.90,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2516.59,"methodology":"percent of total billed charges"}]}]},{"description":"CT LOWER EXTRM W/O C BI ","code_information":[{"code":"73700","type":"CPT"},{"code":"947528","type":"CDM"}],"standard_charges":[{"modifiers":"50","modifiers_description":"Bilateral Procedure","setting":"outpatient","gross_charge":7075.18,"discounted_cash":7075.18,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":3813.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2122.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":3127.23,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2617.82,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":4811.12,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2617.82,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4245.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":3374.86,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2242.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2363.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1995.20,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":4047.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6367.66,"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":6013.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":4952.63,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2830.07,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6367.66,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5660.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3183.83,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1535.31,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1273.53,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":4598.87,"methodology":"percent of total billed charges"}]}]},{"description":"CT MAXIFAC W&W/O CONT ","code_information":[{"code":"70488","type":"CPT"},{"code":"905518","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":6084.91,"discounted_cash":6084.91,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":3279.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1825.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":2689.53,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2251.42,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":4137.74,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2251.42,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":3650.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":2902.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1928.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2032.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1715.94,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":3480.57,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5476.42,"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":5172.17,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":4259.44,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2433.96,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5476.42,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4867.93,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2738.21,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1320.43,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1095.28,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":3955.19,"methodology":"percent of total billed charges"}]}]},{"description":"CT PELVIS W/O CONTRAST ","code_information":[{"code":"72192","type":"CPT"},{"code":"957538","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3558.48,"discounted_cash":3558.48,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1918.02,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1067.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1572.85,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1316.64,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2419.77,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1316.64,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":2135.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1697.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1128.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1188.53,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1003.49,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":2035.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3202.63,"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":3024.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2490.94,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1423.39,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3202.63,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2846.78,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1601.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":772.19,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":640.53,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2313.01,"methodology":"percent of total billed charges"}]}]},{"description":"CT UP EXTREM W/CONT LT ","code_information":[{"code":"73201","type":"CPT"},{"code":"905559","type":"CDM"}],"standard_charges":[{"modifiers":"LT","modifiers_description":"Left side (Used to identify procedures performed on the left side of the body)","setting":"outpatient","gross_charge":3483.92,"discounted_cash":3483.92,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1877.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1045.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1539.89,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1289.05,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2369.07,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1289.05,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":2090.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1661.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1104.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1163.63,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":982.47,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1992.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3135.53,"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":2961.33,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2438.74,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1393.57,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3135.53,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2787.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1567.76,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":756.01,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":627.11,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2264.55,"methodology":"percent of total billed charges"}]}]},{"description":"CTA NECK ","code_information":[{"code":"70498","type":"CPT"},{"code":"905575","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7102.05,"discounted_cash":7102.05,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":3828.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2130.61,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":3139.11,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2627.76,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":4829.39,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2627.76,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4261.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":3387.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2251.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2372.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2002.78,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":4062.37,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6391.85,"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":6036.74,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":4971.44,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2840.82,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6391.85,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5681.64,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3195.92,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1541.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1278.37,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":4616.33,"methodology":"percent of total billed charges"}]}]},{"description":"CULT FUNGUS OTHER SRC ","code_information":[{"code":"87102","type":"CPT"},{"code":"902877","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":283.38,"discounted_cash":283.38,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":152.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":125.25,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":104.85,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":192.70,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":104.85,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":170.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":135.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":89.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":94.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":79.91,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":162.09,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":255.04,"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":240.87,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":198.37,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":113.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":255.04,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":127.52,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":61.49,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":51.01,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":184.20,"methodology":"percent of total billed charges"}]}]},{"description":"CULT TYPING S AUREUS IC ","code_information":[{"code":"114692","type":"CDM"},{"code":"87147","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":67.38,"discounted_cash":67.38,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":36.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":29.78,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":24.93,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":45.82,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":24.93,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":40.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":32.14,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":21.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":22.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":19.00,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":38.54,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":60.64,"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":57.27,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":47.17,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":26.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":60.64,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":30.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":14.62,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":12.13,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":43.80,"methodology":"percent of total billed charges"}]}]},{"description":"CULT W PRESUMPTIVE ID UR ","code_information":[{"code":"87088","type":"CPT"},{"code":"918151","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":68.59,"discounted_cash":68.59,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":36.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":30.32,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":25.38,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":46.64,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":25.38,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":41.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":32.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":21.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":22.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":19.34,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":39.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":61.73,"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":58.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":48.01,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":27.44,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":61.73,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":30.87,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":14.88,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":12.35,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":44.58,"methodology":"percent of total billed charges"}]}]},{"description":"CYCLOSPORIN 0PTH 0.05% ","code_information":[{"code":"944128","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":30.99,"discounted_cash":30.99,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":16.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":9.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":13.70,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":21.07,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":18.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":14.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":9.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":10.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":8.74,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":17.73,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":27.89,"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":26.34,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":21.69,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":12.40,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":23.24,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":27.89,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":24.79,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":13.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":6.72,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":5.58,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":20.14,"methodology":"percent of total billed charges"}]}]},{"description":"CYSTICERCUS AB ","code_information":[{"code":"86682","type":"CPT"},{"code":"947124","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":432.52,"discounted_cash":432.52,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":233.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":191.17,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":160.03,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":294.11,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":160.03,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":259.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":206.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":137.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":144.46,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":121.97,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":247.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":389.27,"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":367.64,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":302.76,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":173.01,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":389.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":194.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":93.86,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":77.85,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":281.14,"methodology":"percent of total billed charges"}]}]},{"description":"D5NS 1000 ML ","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"953489","type":"CDM"},{"code":"J7042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":89.03,"discounted_cash":89.03,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":47.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":26.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":39.35,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":32.94,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":60.54,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":32.94,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":53.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":42.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":28.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":29.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":25.11,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":50.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":80.13,"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":75.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":62.32,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":35.61,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":66.77,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":80.13,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":71.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":40.06,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":19.32,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":16.03,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":57.87,"methodology":"percent of total billed charges"}]}]},{"description":"DANTRLNE(NOT SUSP)20 INJ ","code_information":[{"code":"888499","type":"CDM"},{"code":"J3490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":772.60,"discounted_cash":772.60,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":416.43,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":231.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":341.49,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":285.86,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":525.37,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":285.86,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":463.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":368.53,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":244.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":258.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":217.87,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":441.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":695.34,"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":656.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":540.82,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":309.04,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":579.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":695.34,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":618.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":347.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":167.65,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":139.07,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":502.19,"methodology":"percent of total billed charges"}]}]},{"description":"DASATINIB 50MG TAB ","code_information":[{"code":"943171","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":580.93,"discounted_cash":580.93,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":313.12,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":174.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":256.77,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":395.03,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":348.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":277.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":184.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":194.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":163.82,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":332.29,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":522.84,"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":493.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":406.65,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":232.37,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":435.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":522.84,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":464.74,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":261.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":126.06,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":104.57,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":377.60,"methodology":"percent of total billed charges"}]}]},{"description":"DEFEROX MESY 2000MG INJ ","drug_information":{"unit":"2000","type":"ME"},"code_information":[{"code":"893239","type":"CDM"},{"code":"J0895","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":143.26,"discounted_cash":143.26,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":77.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":42.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":63.32,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":53.01,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":97.42,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":53.01,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":85.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":68.34,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":45.41,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":47.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":40.40,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":81.94,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":128.93,"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":121.77,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":100.28,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":57.30,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":107.44,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":128.93,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":114.61,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":64.47,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":31.09,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":25.79,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":93.12,"methodology":"percent of total billed charges"}]}]},{"description":"DESOXYCORTICOSTERONE ","code_information":[{"code":"82633","type":"CPT"},{"code":"951820","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":225.73,"discounted_cash":225.73,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":121.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":99.77,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":83.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":153.50,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":83.52,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":135.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":107.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":71.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":75.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":63.66,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":129.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":203.16,"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":191.87,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":158.01,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":90.29,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":203.16,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":101.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":48.98,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":40.63,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":146.72,"methodology":"percent of total billed charges"}]}]},{"description":"DEXAMETH 2MG TAB ","code_information":[{"code":"908478","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"DEXAMETH NA PHOS 4 MG ","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"950833","type":"CDM"},{"code":"J1100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":196.37,"discounted_cash":196.37,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":105.84,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":58.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":86.80,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":72.66,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":133.53,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":72.66,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":117.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":93.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":62.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":65.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":55.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":112.32,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":176.73,"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":166.91,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":137.46,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":78.55,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":147.28,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":176.73,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":157.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":88.37,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":42.61,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":35.35,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":127.64,"methodology":"percent of total billed charges"}]}]},{"description":"DEXTROSE 10% 20ML ","code_information":[{"code":"948959","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":72.38,"discounted_cash":72.38,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":39.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":21.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":31.99,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":49.22,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":43.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":34.53,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":22.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":24.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":20.41,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":41.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":65.14,"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":61.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":50.67,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":28.95,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":54.28,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":65.14,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":57.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":32.57,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":15.71,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":13.03,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":47.05,"methodology":"percent of total billed charges"}]}]},{"description":"DEXTROSE 20% 500 ML ","code_information":[{"code":"902129","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":199.85,"discounted_cash":199.85,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":107.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":59.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":88.33,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":135.90,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":119.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":95.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":63.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":66.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":56.36,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":114.31,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":179.87,"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":169.87,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":139.90,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":79.94,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":149.89,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":179.87,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":159.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":89.93,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":43.37,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":35.97,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":129.90,"methodology":"percent of total billed charges"}]}]},{"description":"DIABETES WITH CC ","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"DIGOXIN 50MCG/ML ELIX ","code_information":[{"code":"908678","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"DILTIAZEM 60MG TAB ","code_information":[{"code":"909938","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"DILTIAZEM CD 240MG CAP ","code_information":[{"code":"909939","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":27.25,"discounted_cash":27.25,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":14.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":8.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":12.04,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":18.53,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":16.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":8.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":9.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":7.68,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":15.59,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.52,"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":23.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":19.07,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":10.90,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":20.44,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.52,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":21.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":12.26,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.91,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":17.71,"methodology":"percent of total billed charges"}]}]},{"description":"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC ","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"DIVALPROEX 250MG ER TAB ","code_information":[{"code":"927306","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":24.51,"discounted_cash":24.51,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":13.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":7.35,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":10.83,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":16.67,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":14.71,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":11.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":7.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":8.19,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":6.91,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":14.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":22.06,"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":20.83,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":17.16,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":9.80,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":18.38,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":22.06,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":19.61,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":11.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":5.32,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.41,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":15.93,"methodology":"percent of total billed charges"}]}]},{"description":"DOXORUBICIN 10 MG INJ ","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"906620","type":"CDM"},{"code":"J9000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":165.84,"discounted_cash":165.84,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":89.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":49.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":73.30,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":61.36,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":112.77,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":61.36,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":99.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":79.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":52.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":55.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":46.77,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":94.86,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":149.26,"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":140.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":116.09,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":66.34,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":124.38,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":149.26,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":132.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":74.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":35.99,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":29.85,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":107.80,"methodology":"percent of total billed charges"}]}]},{"description":"DRN BILI G09500 ","code_information":[{"code":"962373","type":"CDM"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":407.87,"discounted_cash":407.87,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":219.84,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":122.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":180.28,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":277.35,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":244.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":194.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":129.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":136.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":115.02,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":233.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":367.08,"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":346.69,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":285.51,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":163.15,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":305.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":367.08,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":326.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":183.54,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":88.51,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":73.42,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":265.12,"methodology":"percent of total billed charges"}]}]},{"description":"DRSG SLVRLN 12X4 ILND ","code_information":[{"code":"842261","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":413.60,"discounted_cash":413.60,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":222.93,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":124.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":182.81,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":281.25,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":248.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":197.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":131.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":138.14,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":116.64,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":236.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":372.24,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":351.56,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":289.52,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":165.44,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":310.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":372.24,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":330.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":186.12,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":89.75,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":74.45,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":268.84,"methodology":"percent of total billed charges"}]}]},{"description":"DRSNG TRANS 2.75X2.25 ","code_information":[{"code":"984896","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1.13,"discounted_cash":1.13,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":0.61,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":0.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":0.77,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":0.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":0.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":0.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":0.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":0.32,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":0.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1.02,"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":0.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":0.79,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":0.45,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":0.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1.02,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":0.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":0.51,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":0.25,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":0.20,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":0.73,"methodology":"percent of total billed charges"}]}]},{"description":"DUP AB/PEL/SC COMP ","code_information":[{"code":"905743","type":"CDM"},{"code":"93975","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":1812.89,"discounted_cash":1812.89,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":977.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":543.87,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":801.30,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":670.77,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1232.77,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":670.77,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1087.73,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":864.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":574.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":605.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":511.23,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1036.97,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1631.60,"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":1540.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1269.02,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":725.16,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1631.60,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1450.31,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":815.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":393.40,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":326.32,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1178.38,"methodology":"percent of total billed charges"}]}]},{"description":"DUP LE ART UNI/LTD ","code_information":[{"code":"93926","type":"CPT"},{"code":"948586","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":483.18,"discounted_cash":483.18,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":260.43,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":144.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":213.57,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":178.78,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":328.56,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":178.78,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":289.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":230.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":153.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":161.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":136.26,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":276.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":434.86,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":410.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":338.23,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":193.27,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":434.86,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":386.54,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":217.43,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":104.85,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":86.97,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":314.07,"methodology":"percent of total billed charges"}]}]},{"description":"E HISTOLYTICA GRP AG EIA ","code_information":[{"code":"87337","type":"CPT"},{"code":"919150","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":343.04,"discounted_cash":343.04,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":184.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":151.62,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":126.92,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":233.27,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":126.92,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":205.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":163.63,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":108.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":114.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":96.74,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":196.22,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":308.74,"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":291.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":240.13,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":137.22,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":308.74,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":154.37,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":74.44,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":61.75,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":222.98,"methodology":"percent of total billed charges"}]}]},{"description":"ECHO STRESS ","code_information":[{"code":"93350","type":"CPT"},{"code":"943467","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2759.11,"discounted_cash":2759.11,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1487.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":827.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1219.53,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1020.87,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1876.19,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1020.87,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1655.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1316.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":874.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":921.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":778.07,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1578.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2483.20,"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":2345.24,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1931.38,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1103.64,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2483.20,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2207.29,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1241.60,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":598.73,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":496.64,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1793.42,"methodology":"percent of total billed charges"}]}]},{"description":"EEG WO VID 12-26 HR INT ","code_information":[{"code":"779048","type":"CDM"},{"code":"95709","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":1456.65,"discounted_cash":1456.65,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":785.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":437.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":643.84,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":538.96,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":990.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":538.96,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":873.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":694.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":461.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":486.52,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":410.78,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":833.20,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1310.98,"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":1238.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1019.65,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":582.66,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1310.98,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1165.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":655.49,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":316.09,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":262.20,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":946.82,"methodology":"percent of total billed charges"}]}]},{"description":"ELECTROLYTE PANEL ","code_information":[{"code":"80051","type":"CPT"},{"code":"902538","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":202.84,"discounted_cash":202.84,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":109.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":89.66,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":75.05,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":137.93,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":75.05,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":121.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":96.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":64.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":67.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":57.20,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":116.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":182.56,"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":172.41,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":141.99,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":81.14,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":182.56,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":91.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":44.02,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":36.51,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":131.85,"methodology":"percent of total billed charges"}]}]},{"description":"EMTRICITABINE 200MG CAP ","code_information":[{"code":"931055","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":184.28,"discounted_cash":184.28,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":99.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":55.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":81.45,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":125.31,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":110.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":87.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":58.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":61.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":51.97,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":105.41,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":165.85,"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":156.64,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":129.00,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":73.71,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":138.21,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":165.85,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":147.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":82.93,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":39.99,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":33.17,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":119.78,"methodology":"percent of total billed charges"}]}]},{"description":"ENDOMYSIAL FA AB IGA SCR ","code_information":[{"code":"86231","type":"CPT"},{"code":"947037","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":808.35,"discounted_cash":808.35,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":435.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":357.29,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":299.09,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":549.68,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":299.09,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":485.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":385.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":256.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":269.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":227.95,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":462.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":727.51,"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":687.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":565.85,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":323.34,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":727.51,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":363.76,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":175.41,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":145.50,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":525.43,"methodology":"percent of total billed charges"}]}]},{"description":"ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC ","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":134373.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":134373.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":112464.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"EPI 2.25%S-2RAC 1ML AMP ","code_information":[{"code":"918216","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":33.36,"discounted_cash":33.36,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":17.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":10.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":14.75,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":22.68,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":20.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":15.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":10.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":11.14,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":9.41,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":19.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":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":28.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":23.35,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":13.34,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":25.02,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":30.02,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":26.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":15.01,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":7.24,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":21.68,"methodology":"percent of total billed charges"}]}]},{"description":"ERYTHROPOIETIN QN ","code_information":[{"code":"82668","type":"CPT"},{"code":"902686","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":551.85,"discounted_cash":551.85,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":297.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":243.92,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":204.18,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":375.26,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":204.18,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":331.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":263.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":174.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":184.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":155.62,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":315.66,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":496.67,"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":469.07,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":386.30,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":220.74,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":496.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":248.33,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":119.75,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":99.33,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":358.70,"methodology":"percent of total billed charges"}]}]},{"description":"ESTROG ESTER 0.625MG ","code_information":[{"code":"911181","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":21.79,"discounted_cash":21.79,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":11.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":6.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":9.63,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":14.82,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":13.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":10.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":7.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":6.14,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":12.46,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.61,"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":18.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":15.25,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":8.72,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":16.34,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.61,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":17.43,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":9.81,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.73,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.92,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":14.16,"methodology":"percent of total billed charges"}]}]},{"description":"ETHYL CHLORIDE SPRAY ","code_information":[{"code":"908509","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":177.03,"discounted_cash":177.03,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":95.42,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":53.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":78.25,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":120.38,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":106.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":84.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":56.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":59.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":49.92,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":101.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":159.33,"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":150.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":123.92,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":70.81,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":132.77,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":159.33,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":141.62,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":79.66,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":38.42,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":31.87,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":115.07,"methodology":"percent of total billed charges"}]}]},{"description":"EVACUATR WND DRN 100CC ","code_information":[{"code":"900297","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":46.59,"discounted_cash":46.59,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":25.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":13.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":20.59,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":31.68,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":27.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":22.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":14.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":15.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":13.14,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":26.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":41.93,"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":39.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":32.61,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":18.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":34.94,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":41.93,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":37.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":20.97,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":10.11,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":8.39,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":30.28,"methodology":"percent of total billed charges"}]}]},{"description":"EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC ","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"EXTRAOCULAR PROCEDURES EXCEPT ORBIT ","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"FACTOR 13 SOLUBILITY ","code_information":[{"code":"85291","type":"CPT"},{"code":"903351","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":495.19,"discounted_cash":495.19,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":266.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":218.87,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":183.22,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":336.73,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":183.22,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":297.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":236.21,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":156.98,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":165.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":139.64,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":283.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":445.67,"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":420.91,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":346.63,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":198.08,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":445.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":222.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":107.46,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":89.13,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":321.87,"methodology":"percent of total billed charges"}]}]},{"description":"FECAL OCCULT BLD CRC IA ","code_information":[{"code":"82274","type":"CPT"},{"code":"946836","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":65.05,"discounted_cash":65.05,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":35.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":28.75,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":24.07,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":44.23,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":24.07,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":39.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":31.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":20.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":21.73,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":18.34,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":37.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":58.55,"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":55.29,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":45.53,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":26.02,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":58.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":29.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":14.12,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":11.71,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":42.28,"methodology":"percent of total billed charges"}]}]},{"description":"FILTER EMBL FEM VC DLV K ","code_information":[{"code":"844037","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":71.03,"discounted_cash":71.03,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":38.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":21.31,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":31.40,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":48.30,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":42.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":33.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":22.52,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":23.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":20.03,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":40.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":63.93,"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":60.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":49.72,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":28.41,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":53.27,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":63.93,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":56.82,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":31.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":15.41,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":12.79,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":46.17,"methodology":"percent of total billed charges"}]}]},{"description":"FINE NDL ASP W MR 1ST ","code_information":[{"code":"789299","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1911.82,"discounted_cash":1911.82,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1030.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":573.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":845.02,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":707.37,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1300.04,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":707.37,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1147.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":911.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":606.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":638.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":539.13,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1093.56,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1720.64,"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":1625.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1338.27,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":764.73,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1433.87,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1720.64,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1529.46,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":860.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":414.86,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":344.13,"methodology":"percent of total billed charges"}]}]},{"description":"FLUORO EVAL OF SWALW SP ","code_information":[{"code":"92611","type":"CPT"},{"code":"949406","type":"CDM"}],"standard_charges":[{"modifiers":"GN","modifiers_description":"Services delivered under an outpatient speech language pathology plan of care","setting":"outpatient","gross_charge":1079.90,"discounted_cash":1079.90,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":582.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":323.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":477.32,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":399.56,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":734.33,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":399.56,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":647.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":515.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":342.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":360.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":304.53,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":617.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":971.91,"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":917.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":755.93,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":431.96,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":809.92,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":971.91,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":863.92,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":485.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":234.34,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":194.38,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":701.93,"methodology":"percent of total billed charges"}]}]},{"description":"FLUPHEN HCL 2.5MG\\ML 10M ","code_information":[{"code":"907199","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":389.30,"discounted_cash":389.30,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":209.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":116.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":172.07,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":264.72,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":233.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":185.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":123.41,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":130.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":109.78,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":222.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.37,"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":330.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":272.51,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":155.72,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":291.98,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.37,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":311.44,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":175.19,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":84.48,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":70.07,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":253.04,"methodology":"percent of total billed charges"}]}]},{"description":"FLUTIC/SAL 115/21MCG12GM ","code_information":[{"code":"952891","type":"CDM"},{"code":"J3535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":10.73,"discounted_cash":10.73,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":5.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":3.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":4.74,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":7.30,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":6.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":5.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":3.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":3.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":3.03,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":6.14,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9.66,"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":9.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":7.51,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":4.29,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":8.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9.66,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":8.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4.83,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":2.33,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1.93,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":6.97,"methodology":"percent of total billed charges"}]}]},{"description":"FLUTIC/SAL100/50MCGINH14 ","code_information":[{"code":"911447","type":"CDM"},{"code":"J3535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":694.49,"discounted_cash":694.49,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":374.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":208.35,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":306.96,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":472.25,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":416.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":331.27,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":220.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":231.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":195.85,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":397.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":625.04,"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":590.32,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":486.14,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":277.80,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":520.87,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":625.04,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":555.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":312.52,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":150.70,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":125.01,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":451.42,"methodology":"percent of total billed charges"}]}]},{"description":"FUROSEMIDE 20MG TAB ","code_information":[{"code":"908535","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"GABAPENTIN 300MG/6ML ","code_information":[{"code":"956808","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1.51,"discounted_cash":1.51,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":0.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":0.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":0.67,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1.03,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":0.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":0.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":0.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":0.43,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":0.86,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1.36,"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":1.28,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1.06,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":0.60,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1.13,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1.36,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1.21,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":0.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":0.33,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":0.27,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":0.98,"methodology":"percent of total billed charges"}]}]},{"description":"GAMMA GT ","code_information":[{"code":"82977","type":"CPT"},{"code":"902452","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":146.15,"discounted_cash":146.15,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":78.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":64.60,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":54.08,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":99.38,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":54.08,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":87.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":69.71,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":46.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":48.81,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":41.21,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":83.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":131.53,"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":124.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":102.31,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":58.46,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":131.53,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":65.77,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":31.71,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":26.31,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":95.00,"methodology":"percent of total billed charges"}]}]},{"description":"GENTAMICIN 80 MG INJ ","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"906730","type":"CDM"},{"code":"J1580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":161.94,"discounted_cash":161.94,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":87.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":48.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":71.58,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":59.92,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":110.12,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":59.92,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":97.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":77.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":51.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":54.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":45.67,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":92.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":145.75,"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":137.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":113.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":64.78,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":121.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":145.75,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":129.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":72.87,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":35.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":29.15,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":105.26,"methodology":"percent of total billed charges"}]}]},{"description":"GLUCOSAMINE SULF 500MG ","code_information":[{"code":"911467","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":0.15,"discounted_cash":0.15,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":0.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":0.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":0.07,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":0.10,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":0.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":0.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":0.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":0.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":0.04,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":0.09,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":0.14,"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":0.13,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":0.10,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":0.06,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":0.11,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":0.14,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":0.12,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":0.07,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":0.03,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":0.03,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":0.10,"methodology":"percent of total billed charges"}]}]},{"description":"GLYCERIN JELLY 60GM ","code_information":[{"code":"949005","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":35.42,"discounted_cash":35.42,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":19.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":10.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":15.66,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":24.09,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":21.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":16.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":11.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":11.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":9.99,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":20.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":31.88,"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":30.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":24.79,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":14.17,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":26.57,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":31.88,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":28.34,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":15.94,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":7.69,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":23.02,"methodology":"percent of total billed charges"}]}]},{"description":"GROWTH HORMONE (HGH) ","code_information":[{"code":"83003","type":"CPT"},{"code":"902695","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":799.40,"discounted_cash":799.40,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":430.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":353.33,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":295.78,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":543.59,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":295.78,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":479.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":381.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":253.41,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":267.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":225.43,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":457.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":719.46,"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":679.49,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":559.58,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":319.76,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":719.46,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":359.73,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":173.47,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":143.89,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":519.61,"methodology":"percent of total billed charges"}]}]},{"description":"GUIDEWIRE VASC .035IN UL ","code_information":[{"code":"846866","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":730.72,"discounted_cash":730.72,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":393.86,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":219.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":322.98,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":496.89,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":438.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":348.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":231.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":244.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":206.06,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":417.97,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":657.65,"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":621.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":511.50,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":292.29,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":548.04,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":657.65,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":584.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":328.82,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":158.57,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":131.53,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":474.97,"methodology":"percent of total billed charges"}]}]},{"description":"GWRE GLD 035 150 ANG ","code_information":[{"code":"919875","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":172.41,"discounted_cash":172.41,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":92.93,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":51.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":76.21,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":117.24,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":103.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":82.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":54.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":57.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":48.62,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":98.62,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":155.17,"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":146.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":120.69,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":68.96,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":129.31,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":155.17,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":137.93,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":77.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":37.41,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":31.03,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":112.07,"methodology":"percent of total billed charges"}]}]},{"description":"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"HEADACHES WITHOUT MCC ","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"HEMODIALYSIS ACUTE ","code_information":[{"code":"906377","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1302.10,"discounted_cash":1302.10,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":701.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":390.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":575.53,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":885.43,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":781.26,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":621.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":412.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":434.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":367.19,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":744.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1171.89,"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":1106.78,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":911.47,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":520.84,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":976.58,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1171.89,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1041.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":585.94,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":282.56,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":234.38,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":846.37,"methodology":"percent of total billed charges"}]}]},{"description":"HEMOGLOBIN FRACT HPLC ","code_information":[{"code":"83021","type":"CPT"},{"code":"946876","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1061.86,"discounted_cash":1061.86,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":572.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":469.34,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":392.89,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":722.06,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":392.89,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":637.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":506.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":336.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":354.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":299.44,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":607.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":955.67,"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":902.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":743.30,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":424.74,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":955.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":477.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":230.42,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":191.13,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":690.21,"methodology":"percent of total billed charges"}]}]},{"description":"HEPA VAC ADULT IM ","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"90632","type":"CPT"},{"code":"907476","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":525.00,"discounted_cash":525.00,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":282.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":157.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":232.05,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":194.25,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":357.00,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":194.25,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":315.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":250.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":166.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":175.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":148.05,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":300.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":472.50,"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":446.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":367.50,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":210.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":393.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":472.50,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":420.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":236.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":113.92,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":94.50,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":341.25,"methodology":"percent of total billed charges"}]}]},{"description":"HEPARIN 5000 U/ML 1 ML V ","code_information":[{"code":"955892","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":155.05,"discounted_cash":155.05,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":83.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":46.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":68.53,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":105.43,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":93.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":73.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":49.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":51.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":43.72,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":88.69,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":139.55,"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":131.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":108.53,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":62.02,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":116.29,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":139.55,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":124.04,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":69.77,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":33.65,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":27.91,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":100.78,"methodology":"percent of total billed charges"}]}]},{"description":"HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"HFE COM VAR C2824 H63D ","code_information":[{"code":"81256","type":"CPT"},{"code":"956854","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1721.58,"discounted_cash":1721.58,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":927.93,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":760.94,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":636.98,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1170.67,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":636.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1032.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":821.19,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":545.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":575.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":485.49,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":984.74,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1549.42,"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":1463.34,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1205.11,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":688.63,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1549.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":774.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":373.58,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":309.88,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1119.03,"methodology":"percent of total billed charges"}]}]},{"description":"HTLV 1 2 ABQL SING ASSAY ","code_information":[{"code":"86790","type":"CPT"},{"code":"947168","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":334.09,"discounted_cash":334.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":180.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":147.67,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":123.61,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":227.18,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":123.61,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":200.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":159.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":105.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":111.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":94.21,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":191.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":300.68,"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":283.98,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":233.86,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":133.64,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":300.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":150.34,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":72.50,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":60.14,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":217.16,"methodology":"percent of total billed charges"}]}]},{"description":"HYDROCODONE/HOMATROP LIQ ","code_information":[{"code":"949014","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":29.98,"discounted_cash":29.98,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":16.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":8.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":13.25,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":20.39,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":17.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":14.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":9.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":10.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":8.45,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":17.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":26.98,"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":25.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":20.99,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":11.99,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":22.48,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":26.98,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":23.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":13.49,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":6.51,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","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":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":19.49,"methodology":"percent of total billed charges"}]}]},{"description":"HYDROXYZINE HCL 25MG TAB ","code_information":[{"code":"908265","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"IBUPROFEN 400MG TAB ","code_information":[{"code":"908593","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"INCIS BX SKIN LESN EA AD ","code_information":[{"code":"788774","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1036.46,"discounted_cash":1036.46,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":558.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":310.94,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":458.12,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":383.49,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":704.79,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":383.49,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":621.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":494.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":328.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":346.18,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":292.28,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":592.86,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":932.81,"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":880.99,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":725.52,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":414.58,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":777.35,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":932.81,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":829.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":466.41,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":224.91,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":186.56,"methodology":"percent of total billed charges"}]}]},{"description":"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC ","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"INFLUENZA VIRUS A AG OIA ","code_information":[{"code":"87804","type":"CPT"},{"code":"947290","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":30.80,"discounted_cash":30.80,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":16.60,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":13.61,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":11.40,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":20.94,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":11.40,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":18.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":14.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":9.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":8.69,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":17.62,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":27.72,"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":26.18,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":21.56,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":12.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":27.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":13.86,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":6.68,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":5.54,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":20.02,"methodology":"percent of total billed charges"}]}]},{"description":"INH ACETYLCYSTN 20% 10ML ","drug_information":{"unit":"2000","type":"ME"},"code_information":[{"code":"893402","type":"CDM"},{"code":"J7608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":428.34,"discounted_cash":428.34,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":230.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":128.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":189.33,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":158.49,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":291.27,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":158.49,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":257.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":204.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":135.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":143.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":120.79,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":245.01,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":385.51,"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":364.09,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":299.84,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":171.34,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":321.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":385.51,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":342.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":192.75,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":92.95,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":77.10,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":278.42,"methodology":"percent of total billed charges"}]}]},{"description":"INH PENTAMIDINE NC 300MG ","drug_information":{"unit":"300","type":"ME"},"code_information":[{"code":"944441","type":"CDM"},{"code":"J2545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":881.97,"discounted_cash":881.97,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":475.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":264.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":389.83,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":326.33,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":599.74,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":326.33,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":529.18,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":420.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":279.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":294.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":248.72,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":504.49,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":793.77,"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":749.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":617.38,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":352.79,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":661.48,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":793.77,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":705.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":396.89,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":191.39,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":158.75,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":573.28,"methodology":"percent of total billed charges"}]}]},{"description":"INJ ARTHRO WRIST RT ","code_information":[{"code":"906142","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":599.16,"discounted_cash":599.16,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":322.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":179.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":264.83,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":221.69,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":407.43,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":221.69,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":359.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":285.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":189.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":200.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":168.96,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":342.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":539.24,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":509.29,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":419.41,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":239.66,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":449.37,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":539.24,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":479.33,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":269.62,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":130.02,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":107.85,"methodology":"percent of total billed charges"}]}]},{"description":"INJ CYSTO/URETH ","code_information":[{"code":"906143","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":713.28,"discounted_cash":713.28,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":384.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":213.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":315.27,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":263.91,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":485.03,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":263.91,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":427.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":340.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":226.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":238.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":201.14,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":408.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":641.95,"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":606.29,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":499.30,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":285.31,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":534.96,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":641.95,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":570.62,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":320.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":154.78,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":128.39,"methodology":"percent of total billed charges"}]}]},{"description":"INJ GEN NRV ANES W FL CT ","code_information":[{"code":"778554","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1874.94,"discounted_cash":1874.94,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1010.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":562.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":828.72,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":693.73,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1274.96,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":693.73,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1124.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":894.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":594.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":626.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":528.73,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1072.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1687.45,"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":1593.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1312.46,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":749.98,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1406.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1687.45,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1499.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":843.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":406.86,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":337.49,"methodology":"percent of total billed charges"}]}]},{"description":"INJ SI JNT ANES W FL CT ","code_information":[{"code":"778553","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1874.94,"discounted_cash":1874.94,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1010.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":562.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":828.72,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":693.73,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1274.96,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":693.73,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1124.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":894.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":594.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":626.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":528.73,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1072.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1687.45,"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":1593.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1312.46,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":749.98,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1406.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1687.45,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1499.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":843.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":406.86,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":337.49,"methodology":"percent of total billed charges"}]}]},{"description":"INS CVC >5YR TUNNELED ","code_information":[{"code":"948447","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5932.72,"discounted_cash":5932.72,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":3197.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1779.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":2622.26,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2195.11,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":4034.25,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2195.11,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":3559.63,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":2829.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1880.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1981.53,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1673.03,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":3393.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5339.45,"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":5042.81,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":4152.90,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2373.09,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4449.54,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5339.45,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4746.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2669.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1287.40,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1067.89,"methodology":"percent of total billed charges"}]}]},{"description":"INSULIN 20 U INJ ","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"796018","type":"CDM"},{"code":"J1815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":4.18,"discounted_cash":4.18,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":2.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1.85,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2.84,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":2.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1.18,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":2.39,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3.76,"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":3.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2.93,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1.67,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":3.13,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3.76,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3.34,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":0.91,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":0.75,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2.72,"methodology":"percent of total billed charges"}]}]},{"description":"INTERF BETA1A 30MCG IM ","drug_information":{"unit":"30","type":"GM"},"code_information":[{"code":"959435","type":"CDM"},{"code":"Q3027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":2714.01,"discounted_cash":2714.01,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1462.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":814.20,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1199.59,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1004.18,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1845.53,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1004.18,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1628.41,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1294.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":860.34,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":906.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":765.35,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1552.41,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2442.61,"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":2306.91,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1899.81,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1085.60,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2442.61,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2171.21,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1221.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":588.94,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":488.52,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1764.11,"methodology":"percent of total billed charges"}]}]},{"description":"INTERSTITIAL LUNG DISEASE WITH MCC ","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC ","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":192300.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":192300.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 16. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":160946.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 16. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"IONTOPHORESIS/15 MIN PT ","code_information":[{"code":"904904","type":"CDM"},{"code":"97033","type":"CPT"}],"standard_charges":[{"modifiers":"GP","modifiers_description":"Services delivered under an outpatient physical therapy plan of care","setting":"outpatient","gross_charge":306.40,"discounted_cash":306.40,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":165.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":91.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":135.43,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":113.37,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":208.35,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":113.37,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":183.84,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":146.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":97.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":102.34,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":86.40,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":175.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":275.76,"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":260.44,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":214.48,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":122.56,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":275.76,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":245.12,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":137.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":66.49,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":55.15,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":199.16,"methodology":"percent of total billed charges"}]}]},{"description":"IRON SUCROSE 100 MG INJ ","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"950865","type":"CDM"},{"code":"J1756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":357.52,"discounted_cash":357.52,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":192.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":107.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":158.02,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":132.28,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":243.11,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":132.28,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":214.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":170.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":113.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":119.41,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":100.82,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":204.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":321.77,"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":303.89,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":250.26,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":143.01,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":268.14,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":321.77,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":286.02,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":160.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":77.58,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":64.35,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":232.39,"methodology":"percent of total billed charges"}]}]},{"description":"ISOSOR DINIT 10MG TAB ","code_information":[{"code":"908628","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"IVIG FLEBOGAMMA 500 MG ","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"943366","type":"CDM"},{"code":"J1572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":430.91,"discounted_cash":430.91,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":232.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":129.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":190.46,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":159.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":293.02,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":159.44,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":258.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":205.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":136.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":143.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":121.52,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":246.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":387.82,"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":366.27,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":301.64,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":172.36,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":387.82,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":344.73,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":193.91,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":93.51,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":77.56,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":280.09,"methodology":"percent of total billed charges"}]}]},{"description":"IVP EA ADD SEQ SAME DRUG ","code_information":[{"code":"950375","type":"CDM"},{"code":"96376","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":177.89,"discounted_cash":177.89,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":95.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":53.37,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":78.63,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":65.82,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":120.97,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":65.82,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":106.73,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":84.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":56.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":59.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":50.16,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":101.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":160.10,"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":151.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":124.52,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":71.16,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":133.42,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":160.10,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":142.31,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":80.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":38.60,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":32.02,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":115.63,"methodology":"percent of total billed charges"}]}]},{"description":"KETOROLAC 15 MG INJ ","drug_information":{"unit":"15","type":"ME"},"code_information":[{"code":"907251","type":"CDM"},{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":217.09,"discounted_cash":217.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":117.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":65.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":95.95,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":80.32,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":147.62,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":80.32,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":130.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":103.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":68.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":72.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":61.22,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":124.18,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":195.38,"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":184.53,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":151.96,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":86.84,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":162.82,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":195.38,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":173.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":97.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":47.11,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":39.08,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":141.11,"methodology":"percent of total billed charges"}]}]},{"description":"KIT MINTRDCR 4FR 10CM ","code_information":[{"code":"464524","type":"CDM"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":389.00,"discounted_cash":389.00,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":209.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":116.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":171.94,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":264.52,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":233.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":185.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":123.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":129.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":109.70,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":222.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.10,"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":330.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":272.30,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":155.60,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":291.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":350.10,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":311.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":175.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":84.41,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":70.02,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":252.85,"methodology":"percent of total billed charges"}]}]},{"description":"LACOSAMIDE 100MG TAB ","code_information":[{"code":"952406","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":59.05,"discounted_cash":59.05,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":31.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":17.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":26.10,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":40.15,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":35.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":28.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":18.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":19.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":16.65,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":33.78,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":53.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":50.19,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":41.34,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":23.62,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":44.29,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":53.15,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":47.24,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":26.57,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":12.81,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":10.63,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":38.38,"methodology":"percent of total billed charges"}]}]},{"description":"LAMOTRIGINE XR 100MG TAB ","code_information":[{"code":"999217","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":30.28,"discounted_cash":30.28,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":16.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":9.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":13.38,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":20.59,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":18.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":14.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":9.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":10.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":8.54,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":17.32,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":27.25,"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":25.74,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":21.20,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":12.11,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":22.71,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":27.25,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":24.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":13.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":6.57,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":5.45,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":19.68,"methodology":"percent of total billed charges"}]}]},{"description":"LETROZOLE 2.5MG TAB ","code_information":[{"code":"911515","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":46.31,"discounted_cash":46.31,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":24.96,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":13.89,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":20.47,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":31.49,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":27.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":22.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":14.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":15.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":13.06,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":26.49,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":41.68,"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":39.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":32.42,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":18.52,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":34.73,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":41.68,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":37.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":20.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":10.05,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":8.34,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":30.10,"methodology":"percent of total billed charges"}]}]},{"description":"LEVETIRACETAM QN ","code_information":[{"code":"80177","type":"CPT"},{"code":"959533","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":82.50,"discounted_cash":82.50,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":44.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":36.47,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":30.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":56.10,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":30.52,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":49.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":39.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":26.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":27.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":23.27,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":47.19,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":74.25,"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":70.13,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":57.75,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":33.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":74.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":37.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":17.90,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":14.85,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":53.63,"methodology":"percent of total billed charges"}]}]},{"description":"LEVOTHYROXINE 88MCG TAB ","code_information":[{"code":"910629","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"LIDO 2% TOP 100ML ","code_information":[{"code":"910231","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":165.37,"discounted_cash":165.37,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":89.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":49.61,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":73.09,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":112.45,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":99.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":78.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":52.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":55.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":46.63,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":94.59,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":148.83,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":140.56,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":115.76,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":66.15,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":124.03,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":148.83,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":132.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":74.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":35.89,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":29.77,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":107.49,"methodology":"percent of total billed charges"}]}]},{"description":"LIDO2%EPI 1:100 20ML INJ ","code_information":[{"code":"907054","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":234.25,"discounted_cash":234.25,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":126.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":70.28,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":103.54,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":159.29,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":140.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":111.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":74.26,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":78.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":66.06,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":133.99,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":210.82,"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":199.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":163.97,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":93.70,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":175.69,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":210.82,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":187.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":105.41,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":50.83,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":42.16,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":152.26,"methodology":"percent of total billed charges"}]}]},{"description":"LIGHT CHAINS LAM FREE ","code_information":[{"code":"83521","type":"CPT"},{"code":"934058","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":325.14,"discounted_cash":325.14,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":175.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":143.71,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":120.30,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":221.10,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":120.30,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":195.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":155.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":103.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":108.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":91.69,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":185.98,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":292.63,"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":276.37,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":227.60,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":130.06,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":292.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":146.31,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":70.56,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":58.53,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":211.34,"methodology":"percent of total billed charges"}]}]},{"description":"LITHIUM CARB 150MG CAP ","code_information":[{"code":"908692","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WIT ","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":50302.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":50302.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":42101.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"LOKELMA 5 G PO ","code_information":[{"code":"781658","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":61.50,"discounted_cash":61.50,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":33.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":18.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":27.18,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":41.82,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":36.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":29.34,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":19.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":20.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":17.34,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":35.18,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":55.35,"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":52.27,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":43.05,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":24.60,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":46.13,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":55.35,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":49.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":27.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":13.35,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":11.07,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":39.98,"methodology":"percent of total billed charges"}]}]},{"description":"LUNG TRANSPLANT ","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":1450.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"LVL 5 EMER DEPT ","code_information":[{"code":"901458","type":"CDM"},{"code":"99285","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":5118.43,"discounted_cash":5118.43,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":2758.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1535.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":2262.35,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1893.82,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":3480.53,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1893.82,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":3071.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":2441.49,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1622.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1709.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1443.40,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":2927.74,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4606.59,"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":4350.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":3582.90,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2047.37,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4606.59,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4094.74,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2303.29,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1110.70,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":921.32,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":3326.98,"methodology":"percent of total billed charges"}]}]},{"description":"LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"MAG SULF 4GM/100ML ","code_information":[{"code":"938798","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":217.02,"discounted_cash":217.02,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":116.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":65.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":95.92,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":147.57,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":130.21,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":103.52,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":68.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":72.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":61.20,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":124.14,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":195.32,"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":184.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":151.91,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":86.81,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":162.76,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":195.32,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":173.62,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":97.66,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":47.09,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":39.06,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":141.06,"methodology":"percent of total billed charges"}]}]},{"description":"MAGNESIUM BLD ","code_information":[{"code":"83735","type":"CPT"},{"code":"902500","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":205.80,"discounted_cash":205.80,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":110.93,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":90.96,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":76.15,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":139.94,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":76.15,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":123.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":98.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":65.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":68.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":58.04,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":117.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":185.22,"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":174.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":144.06,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":82.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":185.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":92.61,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":44.66,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":37.04,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":133.77,"methodology":"percent of total billed charges"}]}]},{"description":"MAJOR CHEST PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND CO ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC ","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"MEGESTROL 40MG TAB ","code_information":[{"code":"908718","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":27.25,"discounted_cash":27.25,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":14.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":8.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":12.04,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":18.53,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":16.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":8.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":9.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":7.68,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":15.59,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.52,"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":23.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":19.07,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":10.90,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":20.44,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.52,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":21.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":12.26,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.91,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":17.71,"methodology":"percent of total billed charges"}]}]},{"description":"MEMANTINE 5MG TAB ","code_information":[{"code":"911716","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":27.25,"discounted_cash":27.25,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":14.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":8.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":12.04,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":18.53,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":16.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":8.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":9.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":7.68,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":15.59,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.52,"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":23.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":19.07,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":10.90,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":20.44,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.52,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":21.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":12.26,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.91,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":17.71,"methodology":"percent of total billed charges"}]}]},{"description":"MESALAMINE 1000 MG SUPP ","code_information":[{"code":"938763","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":9.66,"discounted_cash":9.66,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":5.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":4.27,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":6.57,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":5.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":4.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":3.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":3.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2.72,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":5.53,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8.69,"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":8.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":6.76,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":3.86,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":7.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8.69,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7.73,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":2.10,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1.74,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":6.28,"methodology":"percent of total billed charges"}]}]},{"description":"METHEMOGLOBIN QUANT ","code_information":[{"code":"83050","type":"CPT"},{"code":"946880","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":539.35,"discounted_cash":539.35,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":290.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":238.39,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":199.56,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":366.76,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":199.56,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":323.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":257.27,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":170.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":180.14,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":152.10,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":308.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":485.42,"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":458.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":377.55,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":215.74,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":485.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":242.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":117.04,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":97.08,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":350.58,"methodology":"percent of total billed charges"}]}]},{"description":"METHYLPHENIDATE 20MG TAB ","code_information":[{"code":"907999","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":21.79,"discounted_cash":21.79,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":11.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":6.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":9.63,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":14.82,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":13.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":10.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":7.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":6.14,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":12.46,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.61,"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":18.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":15.25,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":8.72,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":16.34,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.61,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":17.43,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":9.81,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.73,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.92,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":14.16,"methodology":"percent of total billed charges"}]}]},{"description":"METHYLPRED 125MG INJ ","code_information":[{"code":"907141","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":210.19,"discounted_cash":210.19,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":113.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":63.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":92.90,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":142.93,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":126.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":100.26,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":66.63,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":70.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":59.27,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":120.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":189.17,"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":178.66,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":147.13,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":84.08,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":157.64,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":189.17,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":168.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":94.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":45.61,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":37.83,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":136.62,"methodology":"percent of total billed charges"}]}]},{"description":"METHYLPRED ACE 40 MG INJ ","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"121323","type":"CDM"},{"code":"J1010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":17.50,"discounted_cash":17.50,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":9.43,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.74,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":6.47,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":11.90,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":6.47,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":10.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":8.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.84,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.93,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.01,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.75,"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":14.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":12.25,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":13.13,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.75,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":14.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.80,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.15,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":11.38,"methodology":"percent of total billed charges"}]}]},{"description":"METOCLOPRAM 10MG SYRUP ","code_information":[{"code":"909017","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":21.95,"discounted_cash":21.95,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":11.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":6.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":9.70,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":14.93,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":13.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":10.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":7.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":6.19,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":12.56,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.75,"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":18.66,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":15.37,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":8.78,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":16.46,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.75,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":17.56,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":9.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.76,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.95,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":14.27,"methodology":"percent of total billed charges"}]}]},{"description":"MEXILETINE 200MG CAP ","code_information":[{"code":"908770","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":21.79,"discounted_cash":21.79,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":11.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":6.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":9.63,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":14.82,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":13.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":10.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":7.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":6.14,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":12.46,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.61,"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":18.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":15.25,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":8.72,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":16.34,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.61,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":17.43,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":9.81,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.73,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.92,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":14.16,"methodology":"percent of total billed charges"}]}]},{"description":"MINOCYCLINE 50MG CAP ","code_information":[{"code":"908732","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":17.68,"discounted_cash":17.68,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":9.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.81,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.02,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":10.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":8.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.99,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"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":15.03,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":12.38,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":13.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":14.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.84,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.18,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":11.49,"methodology":"percent of total billed charges"}]}]},{"description":"MOMETASONE 200MCG INH 12 ","code_information":[{"code":"886321","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":758.27,"discounted_cash":758.27,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":408.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":227.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":335.16,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":515.62,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":454.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":361.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":240.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":253.26,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":213.83,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":433.73,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":682.44,"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":644.53,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":530.79,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":303.31,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":568.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":682.44,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":606.62,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":341.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":164.54,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":136.49,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":492.88,"methodology":"percent of total billed charges"}]}]},{"description":"MORPHINE EPD/IT PF 5 MG ","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"883381","type":"CDM"},{"code":"J2274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":31.66,"discounted_cash":31.66,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":17.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":9.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":13.99,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":11.71,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":21.53,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":11.71,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":19.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":15.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":10.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":10.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":8.93,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":18.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":28.49,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":26.91,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":22.16,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":12.66,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":23.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":28.49,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":25.33,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":14.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":6.87,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":5.70,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":20.58,"methodology":"percent of total billed charges"}]}]},{"description":"MRI ABDOMEN W/O CONT ","code_information":[{"code":"74181","type":"CPT"},{"code":"947736","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2985.41,"discounted_cash":2985.41,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1609.14,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":895.62,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1319.55,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1104.60,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2030.08,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1104.60,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1791.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1424.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":946.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":997.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":841.89,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1707.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2686.87,"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":2537.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2089.79,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1194.16,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2686.87,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2388.33,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1343.43,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":647.83,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":537.37,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1940.52,"methodology":"percent of total billed charges"}]}]},{"description":"MRI C-SPINE W/CONTRAST ","code_information":[{"code":"72142","type":"CPT"},{"code":"936725","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3921.74,"discounted_cash":3921.74,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":2113.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1176.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1733.41,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1451.04,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2666.78,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1451.04,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":2353.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1870.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1243.19,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1309.86,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1105.93,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":2243.24,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3529.57,"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":3333.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2745.22,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1568.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3529.57,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3137.39,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1764.78,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":851.02,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":705.91,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2549.13,"methodology":"percent of total billed charges"}]}]},{"description":"MRI LOW EXT W/O CONT BI ","code_information":[{"code":"73718","type":"CPT"},{"code":"903590","type":"CDM"}],"standard_charges":[{"modifiers":"50","modifiers_description":"Bilateral Procedure","setting":"outpatient","gross_charge":8455.61,"discounted_cash":8455.61,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":4557.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2536.68,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":3737.38,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":3128.58,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":5749.81,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":3128.58,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":5073.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":4033.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2680.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2824.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2384.48,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":4836.61,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7610.05,"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":7187.27,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":5918.93,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":3382.24,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7610.05,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":6764.49,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3805.02,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1834.87,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1522.01,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":5496.15,"methodology":"percent of total billed charges"}]}]},{"description":"MRI LW JNT W&WO CONT LT ","code_information":[{"code":"73723","type":"CPT"},{"code":"936678","type":"CDM"}],"standard_charges":[{"modifiers":"LT","modifiers_description":"Left side (Used to identify procedures performed on the left side of the body)","setting":"outpatient","gross_charge":6695.37,"discounted_cash":6695.37,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":3608.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2008.61,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":2959.35,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2477.29,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":4552.85,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2477.29,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4017.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":3193.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2122.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2236.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1888.09,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":3829.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6025.83,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5691.06,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":4686.76,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2678.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6025.83,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5356.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3012.92,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1452.90,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1205.17,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":4351.99,"methodology":"percent of total billed charges"}]}]},{"description":"MRI UP JNT W/CONT LT ","code_information":[{"code":"73222","type":"CPT"},{"code":"903617","type":"CDM"}],"standard_charges":[{"modifiers":"LT","modifiers_description":"Left side (Used to identify procedures performed on the left side of the body)","setting":"outpatient","gross_charge":7132.81,"discounted_cash":7132.81,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":3844.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2139.84,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":3152.70,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2639.14,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":4850.31,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2639.14,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4279.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":3402.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2261.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2382.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2011.45,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":4079.97,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6419.53,"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":6062.89,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":4992.97,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2853.12,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6419.53,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5706.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3209.76,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1547.82,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1283.91,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":4636.33,"methodology":"percent of total billed charges"}]}]},{"description":"MYCOPHENOLATE 250 MG PO ","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"910801","type":"CDM"},{"code":"J7517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":34.47,"discounted_cash":34.47,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":18.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":10.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":15.24,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":12.75,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":23.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":12.75,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":20.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":16.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":10.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":11.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":9.72,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":19.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":31.02,"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":29.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":24.13,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":13.79,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":25.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":31.02,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":27.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":15.51,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":7.48,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.20,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":22.41,"methodology":"percent of total billed charges"}]}]},{"description":"MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. ","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"N MENINGITIDIS AG OIA ","code_information":[{"code":"87899","type":"CPT"},{"code":"947296","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":563.75,"discounted_cash":563.75,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":303.86,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":249.18,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":208.59,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":383.35,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":208.59,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":338.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":268.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":178.71,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":188.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":158.98,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":322.46,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":507.38,"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":479.19,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":394.63,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":225.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":507.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":253.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":122.33,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":101.47,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":366.44,"methodology":"percent of total billed charges"}]}]},{"description":"NAPROXEN 500MG TAB ","code_information":[{"code":"908821","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":27.25,"discounted_cash":27.25,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":14.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":8.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":12.04,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":18.53,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":16.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":8.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":9.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":7.68,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":15.59,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.52,"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":23.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":19.07,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":10.90,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":20.44,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.52,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":21.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":12.26,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.91,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":17.71,"methodology":"percent of total billed charges"}]}]},{"description":"NEFAZADONE 150MG TAB ","code_information":[{"code":"910753","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"NIACIN 100MG TAB ","code_information":[{"code":"908790","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"NICOTINE PATCH 14MG ","code_information":[{"code":"908794","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5.45,"discounted_cash":5.45,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":2.94,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1.64,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":2.41,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":3.71,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":3.27,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":2.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1.73,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1.54,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":3.12,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4.91,"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":4.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":3.81,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2.18,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":4.09,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4.91,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4.36,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1.18,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":0.98,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":3.54,"methodology":"percent of total billed charges"}]}]},{"description":"NILOTINIB 200 MG ","code_information":[{"code":"955939","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":551.50,"discounted_cash":551.50,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":297.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":165.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":243.76,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":375.02,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":330.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":263.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":174.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":184.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":155.52,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":315.46,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":496.35,"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":468.77,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":386.05,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":220.60,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":413.63,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":496.35,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":441.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":248.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":119.68,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":99.27,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":358.48,"methodology":"percent of total billed charges"}]}]},{"description":"NITROGLYC CR 6.5MG CAP ","code_information":[{"code":"908854","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"NM BONE WHOLE BODY ","code_information":[{"code":"78306","type":"CPT"},{"code":"903675","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3625.74,"discounted_cash":3625.74,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1954.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1087.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1602.58,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1341.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2465.50,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1341.52,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":2175.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1729.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1149.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1211.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1022.46,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":2073.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3263.17,"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":3081.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2538.02,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1450.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3263.17,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2900.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1631.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":786.79,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":652.63,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2356.73,"methodology":"percent of total billed charges"}]}]},{"description":"NM TUMOR SNG AREA SD IMG ","code_information":[{"code":"779036","type":"CDM"},{"code":"78830","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":3816.15,"discounted_cash":3816.15,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":2056.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1144.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1686.74,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1411.98,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2594.98,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1411.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":2289.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1820.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1209.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1274.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1076.15,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":2182.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3434.53,"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":3243.73,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2671.30,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1526.46,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3434.53,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3052.92,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1717.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":828.10,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":686.91,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2480.50,"methodology":"percent of total billed charges"}]}]},{"description":"NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC ","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"O&P SMEAR CONC ID ","code_information":[{"code":"87177","type":"CPT"},{"code":"902862","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":16.47,"discounted_cash":16.47,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":8.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.28,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":6.09,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":11.20,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":6.09,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":9.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":7.86,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.64,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":9.42,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":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":14.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":11.53,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":6.59,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14.82,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.41,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.57,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2.96,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":10.71,"methodology":"percent of total billed charges"}]}]},{"description":"ONABOTULINUMTOXA 100 U ","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"951015","type":"CDM"},{"code":"J0585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":2667.27,"discounted_cash":2667.27,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1437.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":800.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1178.93,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":986.89,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1813.74,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":986.89,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1600.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1272.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":845.52,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":890.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":752.17,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1525.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2400.54,"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":2267.18,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1867.09,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1066.91,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2400.54,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2133.82,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1200.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":578.80,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":480.11,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1733.73,"methodology":"percent of total billed charges"}]}]},{"description":"OR CLASS III ","code_information":[{"code":"200377","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":182.80,"discounted_cash":182.80,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":98.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":54.84,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":80.80,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":67.64,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":124.30,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":67.64,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":109.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":87.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":57.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":61.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":51.55,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":104.56,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":164.52,"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":155.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":127.96,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":73.12,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":137.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":164.52,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":146.24,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":82.26,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":39.67,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":32.90,"methodology":"percent of total billed charges"}]}]},{"description":"OSELTAMIVIR 75MG CAP ","code_information":[{"code":"911316","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":59.92,"discounted_cash":59.92,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":32.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":17.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":26.48,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":40.75,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":35.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":28.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":18.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":20.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":16.90,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":34.27,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":53.93,"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":50.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":41.94,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":23.97,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":44.94,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":53.93,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":47.94,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":26.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":10.79,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":38.95,"methodology":"percent of total billed charges"}]}]},{"description":"OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC ","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":1450.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC ","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT ","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC ","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"OTHER HEART ASSIST SYSTEM IMPLANT ","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":231023.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":231023.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":193355.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 12. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC ","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC ","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"OXANDROLONE 2.5MG TAB ","code_information":[{"code":"911556","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":49.05,"discounted_cash":49.05,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":26.44,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":14.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":21.68,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":33.35,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":29.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":23.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":15.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":16.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":13.83,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":28.06,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":44.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":41.69,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":34.34,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":19.62,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":36.79,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":44.15,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":39.24,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":22.07,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":10.64,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":8.83,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":31.88,"methodology":"percent of total billed charges"}]}]},{"description":"OXYCOD SOL 5MG/0.25ML ","code_information":[{"code":"953543","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":39.64,"discounted_cash":39.64,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":21.37,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":11.89,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":17.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":26.96,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":23.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":18.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":12.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":13.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":11.18,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":22.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":35.68,"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":33.69,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":27.75,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":15.86,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":29.73,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":35.68,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":31.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":8.60,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":7.14,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":25.77,"methodology":"percent of total billed charges"}]}]},{"description":"PACK SURG STD CNTNTL IR ","code_information":[{"code":"815626","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":379.34,"discounted_cash":379.34,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":204.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":113.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":167.67,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":257.95,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":227.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":180.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":120.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":126.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":106.97,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":216.98,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":341.41,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":322.44,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":265.54,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":151.74,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":284.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":341.41,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":303.47,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":170.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":82.32,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":68.28,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":246.57,"methodology":"percent of total billed charges"}]}]},{"description":"PAP/UREA/CHLOR OINT 30GM ","code_information":[{"code":"918360","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":518.08,"discounted_cash":518.08,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":279.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":155.42,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":228.99,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":352.29,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":310.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":247.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":164.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":173.04,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":146.10,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":296.34,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":466.27,"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":440.37,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":362.66,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":207.23,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":388.56,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":466.27,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":414.46,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":233.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":112.42,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":93.25,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":336.75,"methodology":"percent of total billed charges"}]}]},{"description":"PAROXETINE CR 25MG TAB ","code_information":[{"code":"911639","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38.15,"discounted_cash":38.15,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":20.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":16.86,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":25.94,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":22.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":18.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":12.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":12.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":10.76,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":21.82,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34.34,"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":32.43,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":26.70,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":15.26,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":28.61,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34.34,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":30.52,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":8.28,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.87,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":24.80,"methodology":"percent of total billed charges"}]}]},{"description":"PERC VISC DRN CATH W/IMG ","code_information":[{"code":"994700","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7771.82,"discounted_cash":7771.82,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":4189.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2331.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":3435.14,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2875.57,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":5284.84,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2875.57,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4663.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":3707.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2463.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2595.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2191.65,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":4445.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6994.64,"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":6606.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":5440.27,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":3108.73,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":5828.86,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6994.64,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":6217.46,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3497.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1686.48,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1398.93,"methodology":"percent of total billed charges"}]}]},{"description":"PERIPHERAL VASCULAR DISORDERS WITH MCC ","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8580.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8580.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":7181.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"PERITONEAL ADHESIOLYSIS WITH MCC ","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"PERPHENAZINE 4 MG PO ","drug_information":{"unit":"4","type":"ME"},"code_information":[{"code":"992534","type":"CDM"},{"code":"Q0175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":15.57,"discounted_cash":15.57,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":8.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":4.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":6.88,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":5.76,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":10.59,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":5.76,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":9.34,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":7.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":4.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.39,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":8.91,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14.01,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":13.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":10.90,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":6.23,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":11.68,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14.01,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":12.46,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.01,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.38,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2.80,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":10.12,"methodology":"percent of total billed charges"}]}]},{"description":"PHENAZOPYRIDINE 200MG ","code_information":[{"code":"908988","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":27.25,"discounted_cash":27.25,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":14.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":8.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":12.04,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":18.53,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":16.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":8.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":9.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":7.68,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":15.59,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.52,"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":23.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":19.07,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":10.90,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":20.44,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.52,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":21.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":12.26,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.91,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":17.71,"methodology":"percent of total billed charges"}]}]},{"description":"PHENOBARB 4MG-ML ELIXER ","code_information":[{"code":"910038","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":24.51,"discounted_cash":24.51,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":13.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":7.35,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":10.83,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":16.67,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":14.71,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":11.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":7.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":8.19,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":6.91,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":14.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":22.06,"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":20.83,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":17.16,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":9.80,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":18.38,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":22.06,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":19.61,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":11.03,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":5.32,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.41,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":15.93,"methodology":"percent of total billed charges"}]}]},{"description":"PHENYLEPH 1% SPRAY ","code_information":[{"code":"910446","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":75.15,"discounted_cash":75.15,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":40.51,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":22.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":33.22,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":51.10,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":45.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":35.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":23.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":25.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":21.19,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":42.99,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":67.64,"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":63.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":52.60,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":30.06,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":56.36,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":67.64,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":60.12,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":33.82,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":16.31,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":13.53,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":48.85,"methodology":"percent of total billed charges"}]}]},{"description":"PHENYTOIN 50MG TAB CHEW ","code_information":[{"code":"908431","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"PHOTOPHERESIS EXTRACORP ","code_information":[{"code":"36522","type":"CPT"},{"code":"946208","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":16023.34,"discounted_cash":16023.34,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":8636.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":4807.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7082.32,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":5928.64,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":10895.87,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":5928.64,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":9614.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":7643.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5079.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5351.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4518.58,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":9165.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14421.01,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":13619.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":11216.34,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":6409.34,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14421.01,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":12818.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7210.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3477.06,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2884.20,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":10415.17,"methodology":"percent of total billed charges"}]}]},{"description":"PILOCARP 2% OPHTH 15ML ","code_information":[{"code":"910639","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":219.24,"discounted_cash":219.24,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":118.17,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":65.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":96.90,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":149.08,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":131.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":104.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":69.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":73.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":61.83,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":125.41,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":197.32,"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":186.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":153.47,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":87.70,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":164.43,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":197.32,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":175.39,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":98.66,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":47.58,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":39.46,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":142.51,"methodology":"percent of total billed charges"}]}]},{"description":"PLT AB HEPARIN INDUCED ","code_information":[{"code":"86022","type":"CPT"},{"code":"903376","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":572.70,"discounted_cash":572.70,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":308.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":253.13,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":211.90,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":389.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":211.90,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":343.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":273.18,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":181.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":191.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":161.50,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":327.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":515.43,"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":486.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":400.89,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":229.08,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":515.43,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":257.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":124.28,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":103.09,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":372.25,"methodology":"percent of total billed charges"}]}]},{"description":"POLIOVIRUS II AB ","code_information":[{"code":"86658","type":"CPT"},{"code":"950140","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":174.63,"discounted_cash":174.63,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":94.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":77.19,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":64.61,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":118.75,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":64.61,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":104.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":83.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":55.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":58.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":49.25,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":99.89,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":157.17,"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":148.44,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":122.24,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":69.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":157.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":78.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":37.89,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":31.43,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":113.51,"methodology":"percent of total billed charges"}]}]},{"description":"POT CHLOR 2MEQ/ML ORAL ","code_information":[{"code":"924367","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":17.68,"discounted_cash":17.68,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":9.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.81,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.02,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":10.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":8.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.99,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"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":15.03,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":12.38,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":13.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":14.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.84,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.18,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":11.49,"methodology":"percent of total billed charges"}]}]},{"description":"PREDNISONE 2.5MG TAB ","code_information":[{"code":"910051","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"PRENATAL VT/FE/DOS/FA ","code_information":[{"code":"926580","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":20.01,"discounted_cash":20.01,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":6.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.84,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":13.61,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":12.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.34,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.64,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":18.01,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":17.01,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":14.01,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":8.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":15.01,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":18.01,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":16.01,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":9.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.34,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.60,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":13.01,"methodology":"percent of total billed charges"}]}]},{"description":"PROCHLORPERAZ 10 MG INJ ","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"907105","type":"CDM"},{"code":"J0780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":161.94,"discounted_cash":161.94,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":87.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":48.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":71.58,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":59.92,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":110.12,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":59.92,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":97.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":77.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":51.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":54.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":45.67,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":92.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":145.75,"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":137.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":113.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":64.78,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":121.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":145.75,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":129.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":72.87,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":35.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":29.15,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":105.26,"methodology":"percent of total billed charges"}]}]},{"description":"PROLENE 3-0 8522 ","code_information":[{"code":"917193","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":18.61,"discounted_cash":18.61,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.23,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.65,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":8.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.25,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.64,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":16.75,"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":15.82,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.03,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.44,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":13.96,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":16.75,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":14.89,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.37,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.04,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.35,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.10,"methodology":"percent of total billed charges"}]}]},{"description":"PROMETHAZINE 50MG SUPP ","code_information":[{"code":"908900","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":20.33,"discounted_cash":20.33,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.96,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":6.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.99,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":13.82,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":12.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":11.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":18.30,"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":17.28,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":14.23,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":8.13,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":15.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":18.30,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":16.26,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":9.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.41,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.66,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":13.21,"methodology":"percent of total billed charges"}]}]},{"description":"PROPRANOLOL 20MG TAB ","code_information":[{"code":"908612","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":16.07,"discounted_cash":16.07,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":8.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":4.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.10,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":10.93,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":9.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":7.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.53,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":9.19,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14.46,"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":13.66,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":11.25,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":6.43,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":12.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14.46,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":12.86,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.23,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.49,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2.89,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":10.45,"methodology":"percent of total billed charges"}]}]},{"description":"PROTEIN C AG ","code_information":[{"code":"85302","type":"CPT"},{"code":"903365","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":560.79,"discounted_cash":560.79,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":302.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":247.87,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":207.49,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":381.34,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":207.49,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":336.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":267.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":177.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":187.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":158.14,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":320.77,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":504.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":476.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":392.55,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":224.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":504.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":252.36,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":121.69,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":100.94,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":364.51,"methodology":"percent of total billed charges"}]}]},{"description":"PSYLLIUM MUC PKT ","code_information":[{"code":"908761","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2.76,"discounted_cash":2.76,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":0.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1.22,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1.88,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":0.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":0.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":0.78,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2.48,"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":2.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1.93,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1.10,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2.07,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2.48,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2.21,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1.24,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":0.60,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1.79,"methodology":"percent of total billed charges"}]}]},{"description":"PULMONARY EMBOLISM WITHOUT MCC ","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"QUININE SULF 325MG CAP ","code_information":[{"code":"908998","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"RED BLOOD CELL DISORDERS WITH MCC ","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"REMOVAL IVCF ENDO APRCH ","code_information":[{"code":"955580","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":10299.85,"discounted_cash":10299.85,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":5551.62,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":3089.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":4552.53,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":3810.94,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":7003.90,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":3810.94,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":6179.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":4913.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":3265.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":3440.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2904.56,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":5891.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9269.86,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":8754.87,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":7209.90,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":4119.94,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":7724.89,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":9269.86,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":8239.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4634.93,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":2235.07,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1853.97,"methodology":"percent of total billed charges"}]}]},{"description":"RESP FLOW VOLUME LOOP ","code_information":[{"code":"94375","type":"CPT"},{"code":"946743","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2402.48,"discounted_cash":2402.48,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1294.94,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":720.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1061.90,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":888.92,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1633.69,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":888.92,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1441.49,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1145.98,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":761.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":802.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":677.50,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1374.22,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2162.23,"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":2042.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1681.74,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":960.99,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2162.23,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1921.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1081.12,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":521.34,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":432.45,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1561.61,"methodology":"percent of total billed charges"}]}]},{"description":"RIFAMPIN 300MG CAP ","code_information":[{"code":"909014","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38.15,"discounted_cash":38.15,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":20.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":16.86,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":25.94,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":22.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":18.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":12.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":12.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":10.76,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":21.82,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34.34,"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":32.43,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":26.70,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":15.26,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":28.61,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34.34,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":30.52,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":8.28,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.87,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":24.80,"methodology":"percent of total billed charges"}]}]},{"description":"RIFAXIMIN 20MG OS ","code_information":[{"code":"887355","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5.00,"discounted_cash":5.00,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":2.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":2.21,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":3.40,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":3.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":2.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1.41,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":2.86,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4.50,"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":4.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":3.50,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","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":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4.50,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"GlobalBenefit","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","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1.08,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","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":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":3.25,"methodology":"percent of total billed charges"}]}]},{"description":"RISPERIDONE 0.25MG TAB ","code_information":[{"code":"911413","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":16.07,"discounted_cash":16.07,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":8.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":4.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.10,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":10.93,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":9.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":7.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.53,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":9.19,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14.46,"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":13.66,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":11.25,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":6.43,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":12.05,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14.46,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":12.86,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.23,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.49,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2.89,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":10.45,"methodology":"percent of total billed charges"}]}]},{"description":"RIVASTIGIMINE 9.5MG PTCH ","code_information":[{"code":"943288","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":56.35,"discounted_cash":56.35,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":30.37,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":16.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":24.91,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":38.32,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":33.81,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":26.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":17.86,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":18.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":15.89,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":32.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":50.72,"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":47.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":39.45,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":22.54,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":42.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":50.72,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":45.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":25.36,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":12.23,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":10.14,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":36.63,"methodology":"percent of total billed charges"}]}]},{"description":"ROPINIROLE 0.25MG TAB ","code_information":[{"code":"911400","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"ROPIVACAINE 40 MG INJ ","drug_information":{"unit":"40","type":"ME"},"code_information":[{"code":"951462","type":"CDM"},{"code":"J2795","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":109.07,"discounted_cash":109.07,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":58.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":32.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":48.21,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":40.36,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":74.17,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":40.36,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":65.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":52.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":34.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":36.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":30.76,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":62.39,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":98.16,"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":92.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":76.35,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":43.63,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":81.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":98.16,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":87.26,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":49.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":23.67,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":19.63,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":70.90,"methodology":"percent of total billed charges"}]}]},{"description":"SCOPOLAMINE 0.25% OPH ","code_information":[{"code":"910252","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":190.64,"discounted_cash":190.64,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":102.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":57.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":84.26,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":129.64,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":114.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":90.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":60.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":63.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":53.76,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":109.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":171.58,"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":162.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":133.45,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":76.26,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":142.98,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":171.58,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":152.51,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":85.79,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":41.37,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":34.32,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":123.92,"methodology":"percent of total billed charges"}]}]},{"description":"SEIZURES WITHOUT MCC ","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"SEVELAMER 0.8 GRAM PCKT ","code_information":[{"code":"956508","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":54.04,"discounted_cash":54.04,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":29.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":16.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":23.89,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":36.75,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":32.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":25.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":17.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":18.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":15.24,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":30.91,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":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":45.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":37.83,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":21.62,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":40.53,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":48.64,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":43.23,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":24.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":11.73,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":9.73,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":35.13,"methodology":"percent of total billed charges"}]}]},{"description":"SILVER SULF CRM 20GM TUB ","code_information":[{"code":"992985","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":81.14,"discounted_cash":81.14,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":43.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":24.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":35.86,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":55.18,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":48.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":38.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":25.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":27.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":22.88,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":46.41,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":73.03,"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":68.97,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":56.80,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":32.46,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":60.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":73.03,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":64.91,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":36.51,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":17.61,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":14.61,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":52.74,"methodology":"percent of total billed charges"}]}]},{"description":"SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS ","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":1450.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"SIMVASTATIN 20MG TAB ","code_information":[{"code":"909059","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":17.68,"discounted_cash":17.68,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":9.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.81,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.02,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":10.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":8.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.99,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"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":15.03,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":12.38,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":13.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":14.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.84,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.18,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":11.49,"methodology":"percent of total billed charges"}]}]},{"description":"SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC ","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":46659.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":46659.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":38860.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 5. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"SMEAR MICROSPORIDIUM STN ","code_information":[{"code":"87207","type":"CPT"},{"code":"918256","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":355.82,"discounted_cash":355.82,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":191.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":157.27,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":131.65,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":241.96,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":131.65,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":213.49,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":169.73,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":112.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":118.84,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":100.34,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":203.53,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":320.24,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":302.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":249.07,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":142.33,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":320.24,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":160.12,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":77.21,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":64.05,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":231.28,"methodology":"percent of total billed charges"}]}]},{"description":"SMX/TMP 20 ML VIAL ","code_information":[{"code":"949108","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":654.59,"discounted_cash":654.59,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":352.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":196.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":289.33,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":445.12,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":392.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":312.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":207.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":218.63,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":184.59,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":374.43,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":589.13,"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":556.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":458.21,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":261.84,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":490.94,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":589.13,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":523.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":294.57,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":142.05,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":117.83,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":425.48,"methodology":"percent of total billed charges"}]}]},{"description":"FOLIC ACID 100MCG/ML PO ","code_information":[{"code":"948998","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":8.23,"discounted_cash":8.23,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":4.44,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":3.64,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":5.60,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":3.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2.32,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":4.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7.41,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":7.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":5.76,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":3.29,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":6.17,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7.41,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":6.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1.79,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1.48,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":5.35,"methodology":"percent of total billed charges"}]}]},{"description":"FOSINOPRIL 10MG TAB ","code_information":[{"code":"909358","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"FUNGITELL BETA-D-GLUCAN ","code_information":[{"code":"85130","type":"CPT"},{"code":"943236","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":313.50,"discounted_cash":313.50,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":168.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":138.57,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":116.00,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":213.18,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":116.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":188.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":149.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":99.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":104.71,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":88.41,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":179.32,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":282.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":266.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":219.45,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":125.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":282.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":141.07,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":68.03,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":56.43,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":203.78,"methodology":"percent of total billed charges"}]}]},{"description":"GABAPENTIN 600MG TAB ","code_information":[{"code":"922994","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":27.25,"discounted_cash":27.25,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":14.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":8.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":12.04,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":18.53,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":16.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":8.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":9.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":7.68,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":15.59,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.52,"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":23.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":19.07,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":10.90,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":20.44,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.52,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":21.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":12.26,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.91,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":17.71,"methodology":"percent of total billed charges"}]}]},{"description":"GELATIN FILM 2.5X5CM ","code_information":[{"code":"910701","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":996.78,"discounted_cash":996.78,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":537.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":299.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":440.58,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":677.81,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":598.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":475.46,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":315.98,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":332.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":281.09,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":570.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":897.10,"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":847.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":697.75,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":398.71,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":747.59,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":897.10,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":797.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":448.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":216.30,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":179.42,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":647.91,"methodology":"percent of total billed charges"}]}]},{"description":"GI COCKTAIL ","code_information":[{"code":"908541","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":22.36,"discounted_cash":22.36,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":12.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":6.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":9.88,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":15.20,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":13.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":10.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":7.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":7.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":6.31,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":12.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":20.12,"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":19.01,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":15.65,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":8.94,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":16.77,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":20.12,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":17.89,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":10.06,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.85,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.02,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":14.53,"methodology":"percent of total billed charges"}]}]},{"description":"GLWIRE GOLD 70DG 180 181 ","code_information":[{"code":"962320","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":557.82,"discounted_cash":557.82,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":300.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":167.35,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":246.56,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":379.32,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":334.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":266.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":176.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":186.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":157.31,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":319.07,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":502.04,"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":474.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":390.47,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":223.13,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":418.37,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":502.04,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":446.26,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":251.02,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":121.05,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":100.41,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":362.58,"methodology":"percent of total billed charges"}]}]},{"description":"GLYCOPYROL 0.2MG\\ML 2ML ","code_information":[{"code":"906929","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":106.81,"discounted_cash":106.81,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":57.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":32.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":47.21,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":72.63,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":64.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":50.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":33.86,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":35.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":30.12,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":61.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":96.13,"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":90.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":74.77,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":42.72,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":80.11,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":96.13,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":85.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":48.06,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":23.18,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":19.23,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":69.43,"methodology":"percent of total billed charges"}]}]},{"description":"GUAIFENESIN SYRUP 10ML ","code_information":[{"code":"909007","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"GUIDEWIRE SUPERSTIFF ","code_information":[{"code":"254999","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":291.93,"discounted_cash":291.93,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":157.35,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":87.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":129.03,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":198.51,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":175.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":139.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":92.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":97.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":82.32,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":166.98,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":262.74,"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":248.14,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":204.35,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":116.77,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":218.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":262.74,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":233.54,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":131.37,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":63.35,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":52.55,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":189.75,"methodology":"percent of total billed charges"}]}]},{"description":"GWIRE VASC .014IN 300CM ","code_information":[{"code":"992715","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":1539.00,"discounted_cash":1539.00,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":829.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":461.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":680.24,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1046.52,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":923.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":734.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":487.86,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":514.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":434.00,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":880.31,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1385.10,"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":1308.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1077.30,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":615.60,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1154.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1385.10,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1231.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":692.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":333.96,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":277.02,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1000.35,"methodology":"percent of total billed charges"}]}]},{"description":"GWTX NTRX 018 80 INT A ","code_information":[{"code":"931380","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":874.00,"discounted_cash":874.00,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":471.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":262.20,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":386.31,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":594.32,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":524.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":416.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":277.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":291.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":246.47,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":499.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":786.60,"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":742.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":611.80,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":349.60,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":655.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":786.60,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":699.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":393.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":189.66,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":157.32,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":568.10,"methodology":"percent of total billed charges"}]}]},{"description":"HCG QUALITATIVE SERUM ","code_information":[{"code":"84703","type":"CPT"},{"code":"902453","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":331.08,"discounted_cash":331.08,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":178.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":146.34,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":122.50,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":225.13,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":122.50,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":198.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":157.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":104.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":110.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":93.36,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":189.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":297.97,"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":281.42,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":231.76,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":132.43,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":297.97,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":148.99,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":71.84,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":59.59,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":215.20,"methodology":"percent of total billed charges"}]}]},{"description":"HEPARIN 10000 U/ML 4ML ","code_information":[{"code":"926523","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":22.36,"discounted_cash":22.36,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":12.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":6.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":9.88,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":15.20,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":13.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":10.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":7.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":7.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":6.31,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":12.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":20.12,"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":19.01,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":15.65,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":8.94,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":16.77,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":20.12,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":17.89,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":10.06,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.85,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.02,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":14.53,"methodology":"percent of total billed charges"}]}]},{"description":"HEPARIN COFACTOR II CSA ","code_information":[{"code":"85130","type":"CPT"},{"code":"944398","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":474.53,"discounted_cash":474.53,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":255.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":209.74,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":175.58,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":322.68,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":175.58,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":284.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":226.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":150.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":158.49,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":133.82,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":271.43,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":427.08,"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":403.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":332.17,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":189.81,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":427.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":213.54,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":102.97,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":85.42,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":308.44,"methodology":"percent of total billed charges"}]}]},{"description":"HERPES 6 HUMAN AB IGG QL ","code_information":[{"code":"86790","type":"CPT"},{"code":"947166","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":253.56,"discounted_cash":253.56,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":136.67,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":112.07,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":93.82,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":172.42,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":93.82,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":152.14,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":120.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":80.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":84.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":71.50,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":145.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":228.20,"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":215.53,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":177.49,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":101.42,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":228.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":114.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":55.02,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":45.64,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":164.81,"methodology":"percent of total billed charges"}]}]},{"description":"HERPES SIMP DNA QN ","code_information":[{"code":"87530","type":"CPT"},{"code":"947264","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":165.00,"discounted_cash":165.00,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":88.94,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":72.93,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":61.05,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":112.20,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":61.05,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":99.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":78.71,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":52.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":55.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":46.53,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":94.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":148.50,"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":140.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":115.50,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":66.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":148.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":74.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":35.80,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":29.70,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":107.25,"methodology":"percent of total billed charges"}]}]},{"description":"HEXACHLOR 3% 148ML ","code_information":[{"code":"924290","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":251.52,"discounted_cash":251.52,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":135.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":75.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":111.17,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":171.03,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":150.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":119.98,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":79.73,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":84.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":70.93,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":143.87,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":226.37,"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":213.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":176.06,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":100.61,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":188.64,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":226.37,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":201.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":113.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":54.58,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":45.27,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":163.49,"methodology":"percent of total billed charges"}]}]},{"description":"HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC ","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":37158.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":37158.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":31100.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"HLA 2 TYPE 1 LOCUS HR EA ","code_information":[{"code":"81382","type":"CPT"},{"code":"956911","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3381.65,"discounted_cash":3381.65,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1822.71,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1494.69,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1251.21,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2299.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1251.21,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":2028.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1613.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1071.98,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1129.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":953.63,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1934.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3043.49,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":2874.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2367.16,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1352.66,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3043.49,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1521.74,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":733.82,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":608.70,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2198.07,"methodology":"percent of total billed charges"}]}]},{"description":"HYDRALAZINE 20 MG INJ ","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"117231","type":"CDM"},{"code":"J0360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":160.50,"discounted_cash":160.50,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":86.51,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":48.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":70.94,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":59.38,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":109.14,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":59.38,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":96.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":76.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":50.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":53.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":45.26,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":91.81,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":144.45,"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":136.43,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":112.35,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":64.20,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":120.38,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":144.45,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":128.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":72.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":34.83,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":28.89,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":104.33,"methodology":"percent of total billed charges"}]}]},{"description":"HYDROCOD/CHLOR 5ML ","code_information":[{"code":"924292","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":29.98,"discounted_cash":29.98,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":16.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":8.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":13.25,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":20.39,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":17.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":14.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":9.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":10.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":8.45,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":17.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":26.98,"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":25.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":20.99,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":11.99,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":22.48,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":26.98,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":23.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":13.49,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":6.51,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","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":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":19.49,"methodology":"percent of total billed charges"}]}]},{"description":"HYDROCORT 100MG/2ML VL ","code_information":[{"code":"907136","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":172.28,"discounted_cash":172.28,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":92.86,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":51.68,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":76.15,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":117.15,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":103.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":82.18,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":54.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":57.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":48.58,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":98.54,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":155.05,"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":146.44,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":120.60,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":68.91,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":129.21,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":155.05,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":137.82,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":77.53,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":37.38,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":31.01,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":111.98,"methodology":"percent of total billed charges"}]}]},{"description":"HYDROCORT HEMORR SUPP ","code_information":[{"code":"909398","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2.76,"discounted_cash":2.76,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":0.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1.22,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1.88,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":0.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":0.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":0.78,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2.48,"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":2.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1.93,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1.10,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2.07,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2.48,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2.21,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1.24,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":0.60,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1.79,"methodology":"percent of total billed charges"}]}]},{"description":"HYDROMORPHONE 4MG TAB ","code_information":[{"code":"907965","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":21.79,"discounted_cash":21.79,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":11.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":6.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":9.63,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":14.82,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":13.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":10.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":7.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":6.14,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":12.46,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.61,"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":18.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":15.25,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":8.72,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":16.34,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.61,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":17.43,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":9.81,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.73,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.92,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":14.16,"methodology":"percent of total billed charges"}]}]},{"description":"HYDROXYZINE 2MG/ML LIQ ","code_information":[{"code":"908266","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":17.68,"discounted_cash":17.68,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":9.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.81,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.02,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":10.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":8.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.99,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"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":15.03,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":12.38,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":13.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":14.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.84,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.18,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":11.49,"methodology":"percent of total billed charges"}]}]},{"description":"HYDROXYZINE HCL 50MG TAB ","code_information":[{"code":"909904","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":17.68,"discounted_cash":17.68,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":9.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.81,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.02,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":10.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":8.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.99,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"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":15.03,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":12.38,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":13.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":14.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.84,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.18,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":11.49,"methodology":"percent of total billed charges"}]}]},{"description":"HYPER SALINE SOL 500 ML ","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"883389","type":"CDM"},{"code":"J7131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":263.09,"discounted_cash":263.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":141.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":78.93,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":116.29,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":97.34,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":178.90,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":97.34,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":157.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":125.49,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":83.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":87.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":74.19,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":150.49,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":236.78,"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":223.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":184.16,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":105.24,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":197.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":236.78,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":210.47,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":118.39,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":57.09,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":47.36,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":171.01,"methodology":"percent of total billed charges"}]}]},{"description":"GWIRE VASC 300CM .018IN ","code_information":[{"code":"989986","type":"CDM"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":2622.00,"discounted_cash":2622.00,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1413.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":786.60,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1158.92,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1782.96,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1573.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1250.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":831.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":875.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":739.40,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1499.78,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2359.80,"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":2228.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1835.40,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1048.80,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1966.50,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2359.80,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2097.60,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1179.90,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":568.97,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":471.96,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1704.30,"methodology":"percent of total billed charges"}]}]},{"description":"HALOPERIDOL LACT 5MG INJ ","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"907004","type":"CDM"},{"code":"J1630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":196.37,"discounted_cash":196.37,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":105.84,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":58.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":86.80,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":72.66,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":133.53,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":72.66,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":117.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":93.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":62.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":65.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":55.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":112.32,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":176.73,"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":166.91,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":137.46,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":78.55,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":147.28,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":176.73,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":157.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":88.37,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":42.61,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":35.35,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":127.64,"methodology":"percent of total billed charges"}]}]},{"description":"HEP A AB IGM QUAL ","code_information":[{"code":"86709","type":"CPT"},{"code":"902974","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":220.72,"discounted_cash":220.72,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":118.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":97.56,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":81.67,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":150.09,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":81.67,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":132.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":105.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":69.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":73.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":62.24,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":126.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":198.65,"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":187.61,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":154.50,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":88.29,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":198.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":99.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":47.90,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":39.73,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":143.47,"methodology":"percent of total billed charges"}]}]},{"description":"HEP C AMP PROBE AMP ","code_information":[{"code":"87521","type":"CPT"},{"code":"903179","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1707.86,"discounted_cash":1707.86,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":920.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":754.87,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":631.91,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1161.34,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":631.91,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1024.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":814.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":541.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":570.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":481.62,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":976.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1537.07,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1451.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1195.50,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":683.14,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1537.07,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":768.54,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":370.61,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":307.41,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1110.11,"methodology":"percent of total billed charges"}]}]},{"description":"HEPARIN 10000 U INJ ","drug_information":{"unit":"10000","type":"UN"},"code_information":[{"code":"953727","type":"CDM"},{"code":"J1644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":135.67,"discounted_cash":135.67,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":73.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":40.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":59.97,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":50.20,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":92.26,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":50.20,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":81.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":64.71,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":43.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":45.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":38.26,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":77.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":122.10,"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":115.32,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":94.97,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":54.27,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":101.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":122.10,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":108.54,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":61.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":29.44,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":24.42,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":88.19,"methodology":"percent of total billed charges"}]}]},{"description":"HERPES VIRUS 8 AMP PROBE ","code_information":[{"code":"784247","type":"CDM"},{"code":"87798","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":778.50,"discounted_cash":778.50,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":419.61,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":344.10,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":288.05,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":529.38,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":288.05,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":467.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":371.34,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":246.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":260.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":219.54,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":445.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":700.65,"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":661.73,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":544.95,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":311.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":700.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":350.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":168.93,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":140.13,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":506.02,"methodology":"percent of total billed charges"}]}]},{"description":"HIV WITH MAJOR RELATED CONDITION WITH MCC ","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"HLA TYPAB IDHIDEF QL CL1 ","code_information":[{"code":"86832","type":"CPT"},{"code":"958104","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":512.60,"discounted_cash":512.60,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":276.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":226.57,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":189.66,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":348.57,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":189.66,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":307.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":244.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":162.49,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":171.21,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":144.55,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":293.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":461.34,"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":435.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":358.82,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":205.04,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":461.34,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":230.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":111.23,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":92.27,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":333.19,"methodology":"percent of total billed charges"}]}]},{"description":"HYDROCHLOROTHIAZIDE 50MG ","code_information":[{"code":"908585","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"HYDROCOD/APAP 325/5 TAB ","code_information":[{"code":"951556","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":17.68,"discounted_cash":17.68,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":9.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.81,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.02,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":10.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":8.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.99,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"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":15.03,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":12.38,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":13.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":14.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.84,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.18,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":11.49,"methodology":"percent of total billed charges"}]}]},{"description":"HYDROCORT 1% CR 30GM ","code_information":[{"code":"909977","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2.76,"discounted_cash":2.76,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":0.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1.22,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1.88,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":0.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":0.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":0.78,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2.48,"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":2.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1.93,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1.10,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2.07,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2.48,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2.21,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1.24,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":0.60,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1.79,"methodology":"percent of total billed charges"}]}]},{"description":"HYDROXYQUINOL 300GM OI ","code_information":[{"code":"949023","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":8.20,"discounted_cash":8.20,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":4.42,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":3.62,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":5.58,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":3.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2.31,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":4.69,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7.38,"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":6.97,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":5.74,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":3.28,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":6.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7.38,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":6.56,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1.78,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1.48,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":5.33,"methodology":"percent of total billed charges"}]}]},{"description":"IG HEPAGAM B 0.5 ML IM ","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"943402","type":"CDM"},{"code":"J1571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":1172.72,"discounted_cash":1172.72,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":632.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":351.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":518.34,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":433.91,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":797.45,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":433.91,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":703.63,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":559.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":371.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":391.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":330.71,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":670.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1055.45,"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":996.81,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":820.90,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":469.09,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1055.45,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":938.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":527.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":254.48,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":211.09,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":762.27,"methodology":"percent of total billed charges"}]}]},{"description":"IGG EA ","code_information":[{"code":"82784","type":"CPT"},{"code":"902458","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":193.91,"discounted_cash":193.91,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":104.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":85.71,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":71.75,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":131.86,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":71.75,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":116.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":92.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":61.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":64.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":54.68,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":110.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":174.52,"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":164.82,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":135.74,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":77.56,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":174.52,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":87.26,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":42.08,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":34.90,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":126.04,"methodology":"percent of total billed charges"}]}]},{"description":"INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC ","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"INJ CYSTO/URETH ","code_information":[{"code":"905310","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":713.28,"discounted_cash":713.28,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":384.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":213.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":315.27,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":263.91,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":485.03,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":263.91,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":427.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":340.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":226.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":238.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":201.14,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":408.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":641.95,"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":606.29,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":499.30,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":285.31,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":534.96,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":641.95,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":570.62,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":320.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":154.78,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":128.39,"methodology":"percent of total billed charges"}]}]},{"description":"INJ SI JNT ANES W FL CT ","code_information":[{"code":"778549","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1874.94,"discounted_cash":1874.94,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1010.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":562.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":828.72,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":693.73,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1274.96,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":693.73,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1124.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":894.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":594.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":626.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":528.73,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1072.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1687.45,"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":1593.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1312.46,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":749.98,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1406.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1687.45,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1499.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":843.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":406.86,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":337.49,"methodology":"percent of total billed charges"}]}]},{"description":"INS CVC >5YR NON TUNNEL ","code_information":[{"code":"934793","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1347.73,"discounted_cash":1347.73,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":726.43,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":404.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":595.70,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":498.66,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":916.46,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":498.66,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":808.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":642.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":427.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":450.14,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":380.06,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":770.90,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1212.96,"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":1145.57,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":943.41,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":539.09,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1010.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1212.96,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1078.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":606.48,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":292.46,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":242.59,"methodology":"percent of total billed charges"}]}]},{"description":"INSULIN 20 U INJ ","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"796318","type":"CDM"},{"code":"J1815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":2.78,"discounted_cash":2.78,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":0.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1.23,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1.89,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":0.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":0.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":0.78,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1.59,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2.50,"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":2.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1.95,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1.11,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2.09,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2.50,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":0.60,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":0.50,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1.81,"methodology":"percent of total billed charges"}]}]},{"description":"INTERF BETA1B 0.25MG INJ ","drug_information":{"unit":"0.25","type":"ME"},"code_information":[{"code":"944437","type":"CDM"},{"code":"J1830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":1117.96,"discounted_cash":1117.96,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":602.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":335.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":494.14,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":413.65,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":760.21,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":413.65,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":670.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":533.27,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":354.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":373.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":315.26,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":639.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1006.16,"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":950.27,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":782.57,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":447.18,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1006.16,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":894.37,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":503.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":242.60,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":201.23,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":726.67,"methodology":"percent of total billed charges"}]}]},{"description":"IPRATROPIUM 0.06% INH ","code_information":[{"code":"910673","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":155.91,"discounted_cash":155.91,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":84.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":46.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":68.91,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":106.02,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":93.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":74.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":49.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":52.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":43.97,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":89.18,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":140.32,"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":132.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":109.14,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":62.36,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":116.93,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":140.32,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":124.73,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":70.16,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":33.83,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":28.06,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":101.34,"methodology":"percent of total billed charges"}]}]},{"description":"IVIG OCTAGAM 500 MG ","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"957153","type":"CDM"},{"code":"J1568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":233.25,"discounted_cash":233.25,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":125.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":69.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":103.10,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":86.30,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":158.61,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":86.30,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":139.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":111.26,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":73.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":77.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":65.78,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":133.42,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":209.93,"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":198.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":163.28,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":93.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":209.93,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":186.60,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":104.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":50.62,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":41.98,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":151.61,"methodology":"percent of total billed charges"}]}]},{"description":"KETAMINE 50MG/ML 10ML ","code_information":[{"code":"907048","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":360.60,"discounted_cash":360.60,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":194.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":108.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":159.39,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":245.21,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":216.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":172.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":114.31,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":120.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":101.69,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":206.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":324.54,"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":306.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":252.42,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":144.24,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":270.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":324.54,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":288.48,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":162.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":78.25,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":64.91,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":234.39,"methodology":"percent of total billed charges"}]}]},{"description":"KETOROLAC 60 MG INJ ","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"950867","type":"CDM"},{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":220.45,"discounted_cash":220.45,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":118.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":66.14,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":97.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":81.57,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":149.91,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":81.57,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":132.27,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":105.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":69.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":73.63,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":62.17,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":126.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":198.41,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":187.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":154.31,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":88.18,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":165.34,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":198.41,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":176.36,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":99.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":47.84,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":39.68,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":143.29,"methodology":"percent of total billed charges"}]}]},{"description":"KIT INTRO 4FR MPNCH STF ","code_information":[{"code":"832130","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":562.21,"discounted_cash":562.21,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":303.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":168.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":248.50,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":382.30,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":337.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":268.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":178.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":187.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":158.54,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":321.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":505.99,"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":477.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":393.55,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":224.88,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":421.66,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":505.99,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":449.77,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":252.99,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":122.00,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":101.20,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":365.44,"methodology":"percent of total billed charges"}]}]},{"description":"KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC ","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":20388.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":20388.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":17064.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"LACTATED RINGERS 500 ML ","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"956640","type":"CDM"},{"code":"J7120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":7.11,"discounted_cash":7.11,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":3.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":3.14,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2.63,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":4.83,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2.63,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4.27,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":3.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2.01,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":4.07,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":6.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":4.98,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2.84,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":5.33,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6.40,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1.54,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1.28,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":4.62,"methodology":"percent of total billed charges"}]}]},{"description":"LAMOTRIGINE 100MG ","code_information":[{"code":"910698","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":27.25,"discounted_cash":27.25,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":14.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":8.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":12.04,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":18.53,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":16.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":13.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":8.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":9.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":7.68,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":15.59,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.52,"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":23.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":19.07,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":10.90,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":20.44,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.52,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":21.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":12.26,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.91,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":17.71,"methodology":"percent of total billed charges"}]}]},{"description":"LEAD BLOOD ","code_information":[{"code":"83655","type":"CPT"},{"code":"903335","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":39.60,"discounted_cash":39.60,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":21.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":17.50,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":14.65,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":26.93,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":14.65,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":23.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":18.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":12.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":13.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":11.17,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":22.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":35.64,"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":33.66,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":27.72,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":15.84,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":35.64,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17.82,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":7.13,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":25.74,"methodology":"percent of total billed charges"}]}]},{"description":"LEG PNEUMOPHILIA AG IFT ","code_information":[{"code":"87278","type":"CPT"},{"code":"918253","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":265.47,"discounted_cash":265.47,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":143.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":117.34,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":98.22,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":180.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":98.22,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":159.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":126.63,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":84.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":88.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":74.86,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":151.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":238.92,"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":225.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":185.83,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":106.19,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":238.92,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":119.46,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":57.61,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":47.78,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":172.56,"methodology":"percent of total billed charges"}]}]},{"description":"LETERMOVIR 480 MG PO ","code_information":[{"code":"794546","type":"CDM"},{"code":"J8499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":833.50,"discounted_cash":833.50,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":449.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":250.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":368.41,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":308.39,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":566.78,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":308.39,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":500.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":397.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":264.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":278.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":235.05,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":476.76,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":750.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":708.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":583.45,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":333.40,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":625.13,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":750.15,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":666.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":375.07,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":180.87,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":150.03,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":541.77,"methodology":"percent of total billed charges"}]}]},{"description":"LEVOFLOXACIN 250 MG INJ ","drug_information":{"unit":"250","type":"ME"},"code_information":[{"code":"906881","type":"CDM"},{"code":"J1956","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":489.75,"discounted_cash":489.75,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":263.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":146.93,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":216.47,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":181.21,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":333.03,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":181.21,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":293.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":233.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":155.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":163.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":138.11,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":280.14,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":440.77,"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":416.29,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":342.82,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":195.90,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":367.31,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":440.77,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":391.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":220.39,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":106.28,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":88.16,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":318.34,"methodology":"percent of total billed charges"}]}]},{"description":"LEVOTHYROXINE 200MCG TAB ","code_information":[{"code":"908704","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"LIDO 10MG(0.8%250ML) ","code_information":[{"code":"907314","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":156.38,"discounted_cash":156.38,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":84.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":46.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":69.12,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":106.34,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":93.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":74.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":49.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":52.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":44.10,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":89.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":140.74,"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":132.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":109.47,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":62.55,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":117.28,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":140.74,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":125.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":70.37,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":33.93,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":28.15,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":101.65,"methodology":"percent of total billed charges"}]}]},{"description":"LIDO JELLY 2% 5ML TUBE ","code_information":[{"code":"924313","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":199.85,"discounted_cash":199.85,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":107.72,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":59.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":88.33,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":135.90,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":119.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":95.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":63.35,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":66.75,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":56.36,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":114.31,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":179.87,"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":169.87,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":139.90,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":79.94,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":149.89,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":179.87,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":159.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":89.93,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":43.37,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":35.97,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":129.90,"methodology":"percent of total billed charges"}]}]},{"description":"LIDOCAINE 2% 6ML JELLY ","code_information":[{"code":"115511","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":18.75,"discounted_cash":18.75,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.63,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.29,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.75,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":8.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.26,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.29,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":16.88,"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":15.94,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.13,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.50,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.06,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":16.88,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.07,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.38,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.19,"methodology":"percent of total billed charges"}]}]},{"description":"LIPID SUSP 20% 250ML ","code_information":[{"code":"902202","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":282.51,"discounted_cash":282.51,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":152.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":84.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":124.87,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":192.11,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":169.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":134.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":89.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":94.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":79.67,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":161.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":254.26,"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":240.13,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":197.76,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":113.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":211.88,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":254.26,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":226.01,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":127.13,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":61.30,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":50.85,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":183.63,"methodology":"percent of total billed charges"}]}]},{"description":"LISINOPRIL 5MG TAB ","code_information":[{"code":"909267","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"LOPERAMIDE 2MG/10ML OS ","code_information":[{"code":"999208","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":16.92,"discounted_cash":16.92,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":9.12,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.48,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":11.51,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":10.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":8.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.77,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":9.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.23,"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":14.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":11.84,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":6.77,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":12.69,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.23,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":13.54,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.61,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.67,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.05,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":11.00,"methodology":"percent of total billed charges"}]}]},{"description":"LORAZEPAM 2MG TAB ","code_information":[{"code":"908689","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":17.68,"discounted_cash":17.68,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":9.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.81,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.02,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":10.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":8.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.99,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"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":15.03,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":12.38,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":13.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":14.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.84,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.18,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":11.49,"methodology":"percent of total billed charges"}]}]},{"description":"LUBIPROSTONE 24MCG CAP ","code_information":[{"code":"944388","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":39.64,"discounted_cash":39.64,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":21.37,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":11.89,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":17.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":26.96,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":23.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":18.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":12.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":13.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":11.18,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":22.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":35.68,"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":33.69,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":27.75,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":15.86,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":29.73,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":35.68,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":31.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":8.60,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":7.14,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":25.77,"methodology":"percent of total billed charges"}]}]},{"description":"MAJOR HEAD AND NECK PROCEDURES WITH CC ","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC ","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":29001.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":29001.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":24273.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"MEDICAL BACK PROBLEMS WITHOUT MCC ","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"MERCURY UR QUANT ","code_information":[{"code":"83825","type":"CPT"},{"code":"903342","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":414.63,"discounted_cash":414.63,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":223.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":183.27,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":153.41,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":281.95,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":153.41,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":248.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":197.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":131.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":138.49,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":116.93,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":237.17,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":373.17,"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":352.44,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":290.24,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":165.85,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":373.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":186.58,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":89.97,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":74.63,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":269.51,"methodology":"percent of total billed charges"}]}]},{"description":"METHOCARBAMOL 1G/10ML ","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"907879","type":"CDM"},{"code":"J2800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":189.51,"discounted_cash":189.51,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":102.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":56.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":83.76,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":70.12,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":128.87,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":70.12,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":113.71,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":90.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":60.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":63.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":53.44,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":108.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":170.56,"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":161.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":132.66,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":75.80,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":142.13,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":170.56,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":151.61,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":85.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":41.12,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":34.11,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":123.18,"methodology":"percent of total billed charges"}]}]},{"description":"METHYLMALONIC ACID QN ","code_information":[{"code":"83921","type":"CPT"},{"code":"936111","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":390.76,"discounted_cash":390.76,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":210.62,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":172.72,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":144.58,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":265.72,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":144.58,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":234.46,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":186.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":123.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":130.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":110.19,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":223.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":351.68,"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":332.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":273.53,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":156.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":351.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":175.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":84.79,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":70.34,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":253.99,"methodology":"percent of total billed charges"}]}]},{"description":"METOPROLOL 50MG TAB ","code_information":[{"code":"909997","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"METOPROLOL XL 50MG TB ","code_information":[{"code":"910592","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"METRONIDAZOLE 500MG VL ","code_information":[{"code":"933233","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":292.85,"discounted_cash":292.85,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":157.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":87.86,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":129.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":199.14,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":175.71,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":139.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":92.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":97.81,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":82.58,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":167.51,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":263.57,"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":248.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":205.00,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":117.14,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":219.64,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":263.57,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":234.28,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":131.78,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":63.55,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":52.71,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":190.35,"methodology":"percent of total billed charges"}]}]},{"description":"MICONAZOLE CRM 45GM ","code_information":[{"code":"910010","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":16.34,"discounted_cash":16.34,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":8.81,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":4.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.22,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":11.11,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":9.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":7.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.18,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.46,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.61,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":9.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":13.89,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":11.44,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":6.54,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":12.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":14.71,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":13.07,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.55,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2.94,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":10.62,"methodology":"percent of total billed charges"}]}]},{"description":"MINOR SKIN DISORDERS WITHOUT MCC ","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"MITOCHOND FA AB TIT ","code_information":[{"code":"86381","type":"CPT"},{"code":"902964","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":334.09,"discounted_cash":334.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":180.07,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":147.67,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":123.61,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":227.18,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":123.61,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":200.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":159.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":105.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":111.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":94.21,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":191.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":300.68,"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":283.98,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":233.86,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":133.64,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":300.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":150.34,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":72.50,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":60.14,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":217.16,"methodology":"percent of total billed charges"}]}]},{"description":"MONTELUKAST 10MG TAB ","code_information":[{"code":"911196","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38.15,"discounted_cash":38.15,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":20.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":16.86,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":25.94,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":22.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":18.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":12.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":12.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":10.76,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":21.82,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34.34,"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":32.43,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":26.70,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":15.26,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":28.61,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34.34,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":30.52,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":8.28,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.87,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":24.80,"methodology":"percent of total billed charges"}]}]},{"description":"MORPHINE 2MG/1ML SOLN ","code_information":[{"code":"949065","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":21.79,"discounted_cash":21.79,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":11.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":6.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":9.63,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":14.82,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":13.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":10.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":7.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":6.14,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":12.46,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.61,"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":18.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":15.25,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":8.72,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":16.34,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.61,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":17.43,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":9.81,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.73,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.92,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":14.16,"methodology":"percent of total billed charges"}]}]},{"description":"MORPHN 1MG-ML 50ML INJ ","code_information":[{"code":"907986","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":265.28,"discounted_cash":265.28,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":142.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":79.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":117.25,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":180.39,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":159.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":126.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":84.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":88.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":74.81,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":151.74,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":238.75,"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":225.49,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":185.70,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":106.11,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":198.96,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":238.75,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":212.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":119.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":57.57,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":47.75,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":172.43,"methodology":"percent of total billed charges"}]}]},{"description":"MRA HD W/O CONT ","code_information":[{"code":"70544","type":"CPT"},{"code":"936738","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3094.33,"discounted_cash":3094.33,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1667.84,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":928.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1367.69,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1144.90,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2104.14,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1144.90,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1856.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1476.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":980.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1033.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":872.60,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1769.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2784.90,"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":2630.18,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2166.03,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1237.73,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2784.90,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2475.46,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1392.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":671.47,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":556.98,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2011.31,"methodology":"percent of total billed charges"}]}]},{"description":"MRI BREAST WO CONT RT ","code_information":[{"code":"77046","type":"CPT"},{"code":"788967","type":"CDM"}],"standard_charges":[{"modifiers":"RT","modifiers_description":"Right side (Used to identify procedures performed on the right side of the body)","setting":"outpatient","gross_charge":760.85,"discounted_cash":760.85,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":410.10,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":228.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":336.30,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":281.51,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":517.38,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":281.51,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":456.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":362.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":241.19,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":254.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":214.56,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":435.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":684.76,"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":646.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":532.60,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":304.34,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":684.76,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":608.68,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":342.38,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":165.10,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":136.95,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":494.55,"methodology":"percent of total billed charges"}]}]},{"description":"MRI LOW EXT W&WO CONT RT ","code_information":[{"code":"73720","type":"CPT"},{"code":"903560","type":"CDM"}],"standard_charges":[{"modifiers":"RT","modifiers_description":"Right side (Used to identify procedures performed on the right side of the body)","setting":"outpatient","gross_charge":6695.37,"discounted_cash":6695.37,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":3608.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2008.61,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":2959.35,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2477.29,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":4552.85,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2477.29,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4017.22,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":3193.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2122.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2236.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1888.09,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":3829.75,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6025.83,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5691.06,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":4686.76,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2678.15,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6025.83,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5356.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3012.92,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1452.90,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1205.17,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":4351.99,"methodology":"percent of total billed charges"}]}]},{"description":"MRI PELVIS W&WO CONT ","code_information":[{"code":"72197","type":"CPT"},{"code":"903609","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5812.60,"discounted_cash":5812.60,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":3132.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1743.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":2569.17,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2150.66,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":3952.57,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2150.66,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":3487.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":2772.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1842.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1941.41,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1639.15,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":3324.81,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5231.34,"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":4940.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":4068.82,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2325.04,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5231.34,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4650.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2615.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1261.33,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1046.27,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":3778.19,"methodology":"percent of total billed charges"}]}]},{"description":"MULTIHANCE 10 ML ","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"885236","type":"CDM"},{"code":"A9577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":316.54,"discounted_cash":316.54,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":94.96,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":117.12,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":215.25,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":117.12,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":189.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":150.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":100.34,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":105.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":89.26,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":181.06,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":284.89,"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":269.06,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":221.58,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":126.62,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":237.41,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":284.89,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":253.23,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":142.44,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":68.69,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":56.98,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":205.75,"methodology":"percent of total billed charges"}]}]},{"description":"MULTIVITAMIN 10ML INJ ","code_information":[{"code":"907079","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":182.60,"discounted_cash":182.60,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":98.42,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":54.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":80.71,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":124.17,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":109.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":87.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":57.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":60.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":51.49,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":104.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":164.34,"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":155.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":127.82,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":73.04,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":136.95,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":164.34,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":146.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":82.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":39.62,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":32.87,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":118.69,"methodology":"percent of total billed charges"}]}]},{"description":"NA FERRIC GLUCON 62.5 MG ","drug_information":{"unit":"62.5","type":"ME"},"code_information":[{"code":"950907","type":"CDM"},{"code":"J2916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":539.62,"discounted_cash":539.62,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":290.86,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":161.89,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":238.51,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":199.66,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":366.94,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":199.66,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":323.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":257.40,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":171.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":180.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":152.17,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":308.66,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":485.66,"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":458.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":377.73,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":215.85,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":404.71,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":485.66,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":431.70,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":242.83,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":117.10,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":97.13,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":350.75,"methodology":"percent of total billed charges"}]}]},{"description":"NAPROXEN 250MG TAB ","code_information":[{"code":"908819","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"NDL BX MAXCORE 16GX16 ","code_information":[{"code":"990440","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":259.86,"discounted_cash":259.86,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":140.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":77.96,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":114.86,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":176.70,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":155.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":123.95,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":82.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":86.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":73.28,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":148.64,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":233.87,"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":220.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":181.90,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":103.94,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":194.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":233.87,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":207.89,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":116.94,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":56.39,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":46.77,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":168.91,"methodology":"percent of total billed charges"}]}]},{"description":"NEBIVOLOL 5 MG TAB ","code_information":[{"code":"946356","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":26.37,"discounted_cash":26.37,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":14.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":7.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":11.66,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":17.93,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":15.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":12.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":8.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":8.81,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":7.44,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":15.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":23.73,"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":22.41,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":18.46,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":10.55,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":19.78,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":23.73,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":21.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":11.87,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":5.72,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.75,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":17.14,"methodology":"percent of total billed charges"}]}]},{"description":"NEOMYCIN/BAC/POLY .94GM ","code_information":[{"code":"937848","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":79.01,"discounted_cash":79.01,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":42.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":23.70,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":34.92,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":53.73,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":47.41,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":37.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":25.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":26.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":22.28,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":45.19,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":71.11,"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":67.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":55.31,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":31.60,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":59.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":71.11,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":63.21,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":35.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":17.15,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":14.22,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":51.36,"methodology":"percent of total billed charges"}]}]},{"description":"NIACIN 500MG SR ","code_information":[{"code":"909303","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"NISOLODIPINE 10MG SRTAB ","code_information":[{"code":"911070","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":26.37,"discounted_cash":26.37,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":14.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":7.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":11.66,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":17.93,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":15.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":12.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":8.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":8.81,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":7.44,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":15.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":23.73,"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":22.41,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":18.46,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":10.55,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":19.78,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":23.73,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":21.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":11.87,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":5.72,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.75,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":17.14,"methodology":"percent of total billed charges"}]}]},{"description":"NITROFURANT 50MG CAP ","code_information":[{"code":"908711","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"NM KDNEY FLW&FNC W/RX ","code_information":[{"code":"78708","type":"CPT"},{"code":"903707","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":8765.25,"discounted_cash":8765.25,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":4724.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2629.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":3874.24,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":3243.14,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":5960.37,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":3243.14,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":5259.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":4181.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2778.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2927.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2471.80,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":5013.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7888.73,"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":7450.46,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":6135.68,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":3506.10,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7888.73,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7012.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3944.36,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1902.06,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1577.74,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":5697.41,"methodology":"percent of total billed charges"}]}]},{"description":"NM PARATHY SPECT ","code_information":[{"code":"78071","type":"CPT"},{"code":"958049","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":7206.38,"discounted_cash":7206.38,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":3884.24,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2161.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":3185.22,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2666.36,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":4900.34,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2666.36,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4323.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":3437.44,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2284.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2406.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2032.20,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":4122.05,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6485.74,"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":6125.42,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":5044.47,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2882.55,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":6485.74,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":5765.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3242.87,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1563.78,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1297.15,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":4684.15,"methodology":"percent of total billed charges"}]}]},{"description":"NONTRAUMATIC STUPOR AND COMA WITHOUT MCC ","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"NS 1000 ML ","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"918396","type":"CDM"},{"code":"J7030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":251.75,"discounted_cash":251.75,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":135.69,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":75.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":111.27,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":93.15,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":171.19,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":93.15,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":151.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":120.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":79.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":84.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":70.99,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":144.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":226.57,"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":213.99,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":176.22,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":100.70,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":188.81,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":226.57,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":201.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":113.29,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":54.63,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":45.31,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":163.64,"methodology":"percent of total billed charges"}]}]},{"description":"O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC ","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":1450.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"OCUVITE TAB ","code_information":[{"code":"951376","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":0.31,"discounted_cash":0.31,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":0.17,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":0.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":0.14,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":0.21,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":0.19,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":0.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":0.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":0.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":0.09,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":0.18,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":0.28,"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":0.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":0.22,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":0.12,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":0.23,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":0.28,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":0.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":0.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":0.07,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":0.06,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":0.20,"methodology":"percent of total billed charges"}]}]},{"description":"OLIGOCLONAL BANDS ","code_information":[{"code":"83916","type":"CPT"},{"code":"902573","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":165.00,"discounted_cash":165.00,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":88.94,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":72.93,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":61.05,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":112.20,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":61.05,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":99.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":78.71,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":52.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":55.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":46.53,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":94.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":148.50,"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":140.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":115.50,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":66.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":148.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":74.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":35.80,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":29.70,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":107.25,"methodology":"percent of total billed charges"}]}]},{"description":"OMEPRAZOLE 20MG CAP ","code_information":[{"code":"910337","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":17.73,"discounted_cash":17.73,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":9.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.84,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.06,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":10.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":8.46,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.00,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.14,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.96,"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":15.07,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.09,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":13.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.96,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":14.18,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.98,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.85,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.19,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":11.52,"methodology":"percent of total billed charges"}]}]},{"description":"OP VISIT LEVEL 3 EST ","code_information":[{"code":"904109","type":"CDM"},{"code":"99213","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":67.61,"discounted_cash":67.61,"payers_information":[{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":20.28,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":45.97,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":40.57,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":38.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":60.85,"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":57.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":47.33,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":27.04,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":50.71,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":60.85,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":54.09,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":30.42,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":14.67,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":12.17,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":43.95,"methodology":"percent of total billed charges"}]}]},{"description":"OSMOLALITY BLD ","code_information":[{"code":"83930","type":"CPT"},{"code":"902575","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":241.62,"discounted_cash":241.62,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":130.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":106.80,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":89.40,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":164.30,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":89.40,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":144.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":115.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":76.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":80.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":68.14,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":138.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":217.46,"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":205.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":169.13,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":96.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":217.46,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":108.73,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":52.43,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":43.49,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":157.05,"methodology":"percent of total billed charges"}]}]},{"description":"OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC ","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC ","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC ","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":60907.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":60907.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":50976.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 7. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES ","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"OXYBUTYNIN 5MG XL TAB ","code_information":[{"code":"911313","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38.15,"discounted_cash":38.15,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":20.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":16.86,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":25.94,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":22.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":18.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":12.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":12.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":10.76,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":21.82,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34.34,"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":32.43,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":26.70,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":15.26,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":28.61,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34.34,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":30.52,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":8.28,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.87,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":24.80,"methodology":"percent of total billed charges"}]}]},{"description":"OXYCODONE 15MG ","code_information":[{"code":"949092","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":14.61,"discounted_cash":14.61,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":7.87,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":4.38,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":6.46,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":9.93,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":8.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":6.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":4.63,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":4.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.12,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":8.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":13.15,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":12.42,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":10.23,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":5.84,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":10.96,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":13.15,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":11.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":6.57,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.17,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2.63,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":9.50,"methodology":"percent of total billed charges"}]}]},{"description":"PANCREATIC POLY RIA QN ","code_information":[{"code":"83519","type":"CPT"},{"code":"919186","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1061.86,"discounted_cash":1061.86,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":572.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":469.34,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":392.89,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":722.06,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":392.89,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":637.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":506.51,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":336.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":354.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":299.44,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":607.38,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":955.67,"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":902.58,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":743.30,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":424.74,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":955.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":477.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":230.42,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":191.13,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":690.21,"methodology":"percent of total billed charges"}]}]},{"description":"PAPDX TCSC NRSC BETH ","code_information":[{"code":"88164","type":"CPT"},{"code":"903242","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":231.77,"discounted_cash":231.77,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":124.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":102.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":85.75,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":157.60,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":85.75,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":139.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":110.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":73.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":77.41,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":65.36,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":132.57,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":208.59,"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":197.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":162.24,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":92.71,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":208.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":104.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":50.29,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":41.72,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":150.65,"methodology":"percent of total billed charges"}]}]},{"description":"TAPENTADOL 100MG PO ","code_information":[{"code":"955550","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":39.64,"discounted_cash":39.64,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":21.37,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":11.89,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":17.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":26.96,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":23.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":18.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":12.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":13.24,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":11.18,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":22.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":35.68,"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":33.69,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":27.75,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":15.86,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":29.73,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":35.68,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":31.71,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":8.60,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":7.14,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":25.77,"methodology":"percent of total billed charges"}]}]},{"description":"TEE2D W OR W&WO INT/RPT ","code_information":[{"code":"943460","type":"CDM"},{"code":"C8925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":1831.45,"discounted_cash":1831.45,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":987.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":549.43,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":809.50,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":677.64,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1245.39,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":677.64,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1098.87,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":873.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":580.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":611.70,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":516.47,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1047.59,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1648.31,"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":1556.73,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1282.02,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":732.58,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1648.31,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1465.16,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":824.15,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":397.42,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":329.66,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1190.44,"methodology":"percent of total billed charges"}]}]},{"description":"TERAZOSIN 2MG TAB ","code_information":[{"code":"909179","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"TETANUS IG HUMAN 250 U ","drug_information":{"unit":"250","type":"UN"},"code_information":[{"code":"943381","type":"CDM"},{"code":"J1670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":592.60,"discounted_cash":592.60,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":319.41,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":177.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":261.93,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":219.26,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":402.97,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":219.26,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":355.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":282.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":187.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":197.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":167.11,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":338.97,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":533.34,"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":503.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":414.82,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":237.04,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":533.34,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":474.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":266.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":128.59,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":106.67,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":385.19,"methodology":"percent of total billed charges"}]}]},{"description":"THEOPHYLLIN 300MG CRTAB ","code_information":[{"code":"909117","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"THORACENTESIS W/ IMAG ","code_information":[{"code":"957734","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3004.33,"discounted_cash":3004.33,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1619.33,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":901.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1327.91,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1111.60,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2042.94,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1111.60,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1802.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1433.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":952.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1003.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":847.22,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1718.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2703.90,"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":2553.68,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2103.03,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1201.73,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":2253.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2703.90,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2403.46,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1351.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":651.94,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":540.78,"methodology":"percent of total billed charges"}]}]},{"description":"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC ","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"TIMOLOL XE GEL0.5% 2.5ML ","code_information":[{"code":"910586","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":26.75,"discounted_cash":26.75,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":14.42,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":8.03,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":11.82,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":18.19,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":16.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":12.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":8.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":8.93,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":7.54,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":15.30,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.07,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":22.74,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":18.73,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":10.70,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":20.06,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":24.07,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":21.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":12.04,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":5.80,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.82,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":17.39,"methodology":"percent of total billed charges"}]}]},{"description":"TOBRAMYCIN 80 MG INJ ","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"52252","type":"CDM"},{"code":"J3260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":416.50,"discounted_cash":416.50,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":224.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":124.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":184.09,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":154.10,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":283.22,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":154.10,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":249.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":198.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":132.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":139.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":117.45,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":238.24,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":374.85,"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":354.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":291.55,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":166.60,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":312.38,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":374.85,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":333.20,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":187.43,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":90.38,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":74.97,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":270.73,"methodology":"percent of total billed charges"}]}]},{"description":"TOCAINIDE 400MG TAB ","code_information":[{"code":"910095","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":21.79,"discounted_cash":21.79,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":11.74,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":6.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":9.63,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":14.82,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":13.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":10.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":7.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":6.14,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":12.46,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.61,"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":18.52,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":15.25,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":8.72,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":16.34,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":19.61,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":17.43,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":9.81,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.73,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.92,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":14.16,"methodology":"percent of total billed charges"}]}]},{"description":"TPN 1000ML ","code_information":[{"code":"907930","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":775.21,"discounted_cash":775.21,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":417.84,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":232.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":342.64,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":527.14,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":465.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":369.78,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":245.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":258.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":218.61,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":443.42,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":697.69,"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":658.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":542.65,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":310.08,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":581.41,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":697.69,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":620.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":348.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":168.22,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":139.54,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":503.89,"methodology":"percent of total billed charges"}]}]},{"description":"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC ","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"TRANSURETHRAL PROCEDURES WITH CC ","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"TRAVOPROST 2.5ML OPH SOL ","code_information":[{"code":"924421","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":467.15,"discounted_cash":467.15,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":251.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":140.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":206.48,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":317.66,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":280.29,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":222.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":148.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":156.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":131.74,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":267.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":420.44,"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":397.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":327.00,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":186.86,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":350.36,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":420.44,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":373.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":210.22,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":101.37,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":84.09,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":303.65,"methodology":"percent of total billed charges"}]}]},{"description":"TRIAMCIN 0.1% LOT ","code_information":[{"code":"910100","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":230.90,"discounted_cash":230.90,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":124.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":69.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":102.06,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":157.01,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":138.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":110.14,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":73.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":77.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":65.11,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":132.07,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":207.81,"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":196.26,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":161.63,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":92.36,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":173.18,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":207.81,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":184.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":103.91,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":50.11,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":41.56,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":150.09,"methodology":"percent of total billed charges"}]}]},{"description":"TRIMETHBENZMD 200 MG INJ ","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"907156","type":"CDM"},{"code":"J3250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":33.36,"discounted_cash":33.36,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":17.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":10.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":14.75,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":12.34,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":22.68,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":12.34,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":20.02,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":15.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":10.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":11.14,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":9.41,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":19.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":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":28.36,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":23.35,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":13.34,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":25.02,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":30.02,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":26.69,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":15.01,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":7.24,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":21.68,"methodology":"percent of total billed charges"}]}]},{"description":"COMP C4 BIND PROT IA QN ","code_information":[{"code":"83520","type":"CPT"},{"code":"946895","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":692.01,"discounted_cash":692.01,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":372.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":305.87,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":256.04,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":470.57,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":256.04,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":415.21,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":330.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":219.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":231.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":195.15,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":395.83,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":622.81,"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":588.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":484.41,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":276.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":622.81,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":311.40,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":150.17,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":124.56,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":449.81,"methodology":"percent of total billed charges"}]}]},{"description":"CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION ","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":52158.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":52158.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":43654.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 3. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC ","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":83595.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":83595.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":69965.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 9. "},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC ","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":13741.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":13741.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":11501.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":1150.00,"methodology":"per diem"}]}]},{"description":"CORTISOL TOTAL ","code_information":[{"code":"82533","type":"CPT"},{"code":"902556","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":352.01,"discounted_cash":352.01,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":189.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":155.59,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":130.24,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":239.37,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":130.24,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":211.21,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":167.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":111.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":117.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":99.27,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":201.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":316.81,"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":299.21,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":246.41,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":140.80,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":316.81,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","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","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":76.39,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","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":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":228.81,"methodology":"percent of total billed charges"}]}]},{"description":"COVID-19 DNA/RNA AMP ","code_information":[{"code":"774673","type":"CDM"},{"code":"87635","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":70.00,"discounted_cash":70.00,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":37.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":30.94,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":25.90,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":47.60,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":25.90,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":42.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":33.39,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":22.19,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":23.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":19.74,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":40.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":63.00,"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":59.50,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":49.00,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":28.00,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":63.00,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":31.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":15.19,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":12.60,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":45.50,"methodology":"percent of total billed charges"}]}]},{"description":"COXSACKIE B AB QL ","code_information":[{"code":"86658","type":"CPT"},{"code":"947112","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":220.72,"discounted_cash":220.72,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":118.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":97.56,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":81.67,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":150.09,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":81.67,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":132.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":105.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":69.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":73.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":62.24,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":126.25,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":198.65,"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":187.61,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":154.50,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":88.29,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":198.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":99.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":47.90,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":39.73,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":143.47,"methodology":"percent of total billed charges"}]}]},{"description":"CT ABD&PELVIS W/O CONT ","code_information":[{"code":"74176","type":"CPT"},{"code":"953047","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2845.10,"discounted_cash":2845.10,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1533.51,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":853.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1257.53,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1052.69,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1934.67,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1052.69,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1707.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1357.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":901.90,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":950.26,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":802.32,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1627.40,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2560.59,"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":2418.34,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1991.57,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1138.04,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2560.59,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2276.08,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1280.30,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":617.39,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":512.12,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1849.32,"methodology":"percent of total billed charges"}]}]},{"description":"CT ABDOMEN W/CONT ","code_information":[{"code":"74160","type":"CPT"},{"code":"905538","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":5697.16,"discounted_cash":5697.16,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":3070.77,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1709.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":2518.14,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2107.95,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":3874.07,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2107.95,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":3418.30,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":2717.55,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1806.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1902.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1606.60,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":3258.78,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5127.44,"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":4842.59,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":3988.01,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2278.86,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5127.44,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4557.73,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2563.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1236.28,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1025.49,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":3703.15,"methodology":"percent of total billed charges"}]}]},{"description":"CT L-SPINE W/CONTRAST ","code_information":[{"code":"72132","type":"CPT"},{"code":"937199","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4456.31,"discounted_cash":4456.31,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":2401.95,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1336.89,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1969.69,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1648.83,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":3030.29,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1648.83,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":2673.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":2125.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1412.65,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1488.41,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1256.68,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":2549.01,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4010.68,"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":3787.86,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":3119.42,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1782.52,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":4010.68,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3565.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2005.34,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":967.02,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":802.14,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2896.60,"methodology":"percent of total billed charges"}]}]},{"description":"CT LOWER EXTRM W/CON LT ","code_information":[{"code":"73701","type":"CPT"},{"code":"905556","type":"CDM"}],"standard_charges":[{"modifiers":"LT","modifiers_description":"Left side (Used to identify procedures performed on the left side of the body)","setting":"outpatient","gross_charge":5603.26,"discounted_cash":5603.26,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":3020.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1680.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":2476.64,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2073.21,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":3810.22,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2073.21,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":3361.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":2672.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1776.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1871.49,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1580.12,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":3205.06,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5042.93,"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":4762.77,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":3922.28,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2241.30,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5042.93,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4482.61,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2521.47,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1215.91,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1008.59,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":3642.12,"methodology":"percent of total billed charges"}]}]},{"description":"CT LTD/LOC ","code_information":[{"code":"76380","type":"CPT"},{"code":"905540","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2693.47,"discounted_cash":2693.47,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1451.78,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":808.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1190.51,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":996.58,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1831.56,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":996.58,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1616.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1284.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":853.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":899.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":759.56,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1540.66,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2424.12,"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":2289.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1885.43,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1077.39,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2424.12,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2154.78,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1212.06,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":584.48,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":484.82,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1750.76,"methodology":"percent of total billed charges"}]}]},{"description":"CT NECK W/CONTRAST ","code_information":[{"code":"70491","type":"CPT"},{"code":"905521","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":4011.88,"discounted_cash":4011.88,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":2162.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1203.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1773.25,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1484.40,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2728.08,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1484.40,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":2407.13,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1913.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1271.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1339.97,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1131.35,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":2294.80,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3610.69,"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":3410.10,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2808.32,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1604.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3610.69,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3209.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1805.35,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":870.58,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":722.14,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2607.72,"methodology":"percent of total billed charges"}]}]},{"description":"CT T-SPINE W/O CONTRAST ","code_information":[{"code":"72128","type":"CPT"},{"code":"937203","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":3871.67,"discounted_cash":3871.67,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":2086.83,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1161.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1711.28,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1432.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2632.74,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1432.52,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":2323.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1846.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1227.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1293.14,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1091.81,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":2214.60,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3484.50,"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":3290.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2710.17,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1548.67,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3484.50,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":3097.34,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1742.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":840.15,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":696.90,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2516.59,"methodology":"percent of total billed charges"}]}]},{"description":"CT UP EXTREM W/O CONT RT ","code_information":[{"code":"73200","type":"CPT"},{"code":"944898","type":"CDM"}],"standard_charges":[{"modifiers":"RT","modifiers_description":"Right side (Used to identify procedures performed on the right side of the body)","setting":"outpatient","gross_charge":3510.78,"discounted_cash":3510.78,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1892.31,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1053.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1551.76,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1298.99,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2387.33,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1298.99,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":2106.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1674.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1112.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1172.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":990.04,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":2008.17,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3159.70,"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":2984.16,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2457.55,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1404.31,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":3159.70,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2808.62,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1579.85,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":761.84,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":631.94,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":2282.01,"methodology":"percent of total billed charges"}]}]},{"description":"CTA UPPER EXTREMITY LT ","code_information":[{"code":"73206","type":"CPT"},{"code":"937183","type":"CDM"}],"standard_charges":[{"modifiers":"LT","modifiers_description":"Left side (Used to identify procedures performed on the left side of the body)","setting":"outpatient","gross_charge":5980.55,"discounted_cash":5980.55,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":3223.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":1794.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":2643.40,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2212.80,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":4066.77,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":2212.80,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":3588.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":2852.72,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":1895.83,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1997.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":1686.52,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":3420.87,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5382.49,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":5083.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":4186.39,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":2392.22,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":5382.49,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":4784.44,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":2691.25,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1297.78,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1076.50,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":3887.36,"methodology":"percent of total billed charges"}]}]},{"description":"CULT TYPING PFGE ","code_information":[{"code":"87152","type":"CPT"},{"code":"918254","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1870.23,"discounted_cash":1870.23,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1008.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":826.64,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":691.99,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1271.76,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":691.99,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1122.14,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":892.10,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":592.86,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":624.66,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":527.40,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1069.77,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1683.21,"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":1589.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1309.16,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":748.09,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1683.21,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":841.60,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":405.84,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":336.64,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1215.65,"methodology":"percent of total billed charges"}]}]},{"description":"CULT TYPING SEQ EA ISO ","code_information":[{"code":"87153","type":"CPT"},{"code":"952428","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1486.80,"discounted_cash":1486.80,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":801.39,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":657.17,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":550.12,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1011.02,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":550.12,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":892.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":709.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":471.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":496.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":419.28,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":850.45,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1338.12,"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":1263.78,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1040.76,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":594.72,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1338.12,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":669.06,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":322.64,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":267.62,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":966.42,"methodology":"percent of total billed charges"}]}]},{"description":"CULTURE STOOL ","code_information":[{"code":"87045","type":"CPT"},{"code":"902905","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":426.54,"discounted_cash":426.54,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":229.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":188.53,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":157.82,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":290.05,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":157.82,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":255.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":203.46,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":135.21,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":142.46,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":120.28,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":243.98,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":383.89,"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":362.56,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":298.58,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":170.62,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":383.89,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":191.94,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":92.56,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":76.78,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":277.25,"methodology":"percent of total billed charges"}]}]},{"description":"CYSTATIN C ","code_information":[{"code":"82610","type":"CPT"},{"code":"944064","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":438.48,"discounted_cash":438.48,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":236.34,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":193.81,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":162.24,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":298.17,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":162.24,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":263.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":209.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":139.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":146.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":123.65,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":250.81,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":394.63,"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":372.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":306.94,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":175.39,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":394.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":197.32,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":95.15,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":78.93,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":285.01,"methodology":"percent of total billed charges"}]}]},{"description":"D 5%-0.45NACL K10MEQ0.5L ","code_information":[{"code":"948938","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":203.31,"discounted_cash":203.31,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":109.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":60.99,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":89.86,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":138.25,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":121.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":96.98,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":64.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":67.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":57.33,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":116.29,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":182.98,"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":172.81,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":142.32,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":81.32,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":152.48,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":182.98,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":162.65,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":91.49,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":44.12,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":36.60,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":132.15,"methodology":"percent of total billed charges"}]}]},{"description":"DALTEPARIN 5000 U INJ ","drug_information":{"unit":"5000","type":"UN"},"code_information":[{"code":"953248","type":"CDM"},{"code":"J1645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":380.79,"discounted_cash":380.79,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":205.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":114.24,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":168.31,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":140.89,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":258.94,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":140.89,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":228.47,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":181.64,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":120.71,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":127.18,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":107.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":217.81,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":342.71,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":323.67,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":266.55,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":152.32,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":285.59,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":342.71,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":304.63,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":171.36,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":82.63,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":68.54,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":247.51,"methodology":"percent of total billed charges"}]}]},{"description":"DARIFENACIN 7.5MG SR TAB ","code_information":[{"code":"935545","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":43.60,"discounted_cash":43.60,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":23.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":13.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":19.27,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":29.65,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":26.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":20.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":13.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":14.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":12.30,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":24.94,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":39.24,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":37.06,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":30.52,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":17.44,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":32.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":39.24,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":34.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":19.62,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":9.46,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":7.85,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":28.34,"methodology":"percent of total billed charges"}]}]},{"description":"DEF DRUG ALCOHOLS BM 1-2 ","code_information":[{"code":"80321","type":"CPT"},{"code":"883653","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":231.00,"discounted_cash":231.00,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":124.51,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":69.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":102.10,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":85.47,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":157.08,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":85.47,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":138.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":110.19,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":73.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":77.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":65.14,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":132.13,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":207.90,"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":196.35,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":161.70,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":92.40,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":173.25,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":207.90,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":184.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":103.95,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":50.13,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":41.58,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":150.15,"methodology":"percent of total billed charges"}]}]},{"description":"DESONIDE 0.05% 15GM CR ","code_information":[{"code":"910097","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":144.35,"discounted_cash":144.35,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":77.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":43.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":63.80,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":98.16,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":86.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":68.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":45.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":48.21,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":40.71,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":82.57,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":129.91,"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":122.70,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":101.05,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":57.74,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":108.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":129.91,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":115.48,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":64.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":31.32,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":25.98,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":93.83,"methodology":"percent of total billed charges"}]}]},{"description":"DEX 5%-NACL 0.2% 500ML ","code_information":[{"code":"902093","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":44.55,"discounted_cash":44.55,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":24.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":13.37,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":19.69,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":30.29,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":26.73,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":21.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":14.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":14.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":12.56,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":25.48,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":40.09,"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":37.87,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":31.18,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":17.82,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":33.41,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":40.09,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":35.64,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":20.05,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":9.67,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":8.02,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":28.96,"methodology":"percent of total billed charges"}]}]},{"description":"DEXAMETH NA PHOS 10 MG ","drug_information":{"unit":"10","type":"ME"},"code_information":[{"code":"953726","type":"CDM"},{"code":"J1100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":112.53,"discounted_cash":112.53,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":60.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":33.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":49.74,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":41.64,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":76.52,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":41.64,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":67.52,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":53.68,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":35.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":37.59,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":31.73,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":64.37,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":101.28,"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":95.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":78.77,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":45.01,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":84.40,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":101.28,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":90.02,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":50.64,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":24.42,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":20.26,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":73.14,"methodology":"percent of total billed charges"}]}]},{"description":"DEXTROMETHORPH 30MG/5ML ","code_information":[{"code":"926499","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":0.15,"discounted_cash":0.15,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":0.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":0.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":0.07,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":0.10,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":0.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":0.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":0.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":0.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":0.04,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":0.09,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":0.14,"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":0.13,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":0.10,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":0.06,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":0.11,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":0.14,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":0.12,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":0.07,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":0.03,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":0.03,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":0.10,"methodology":"percent of total billed charges"}]}]},{"description":"DEXTROSE 10% 250ML ","code_information":[{"code":"902084","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":161.94,"discounted_cash":161.94,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":87.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":48.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":71.58,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":110.12,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":97.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":77.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":51.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":54.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":45.67,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":92.63,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":145.75,"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":137.65,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":113.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":64.78,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":121.45,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":145.75,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":129.55,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":72.87,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":35.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":29.15,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":105.26,"methodology":"percent of total billed charges"}]}]},{"description":"DEXTROSE 50% SYRINGE ","code_information":[{"code":"907228","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":8.26,"discounted_cash":8.26,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":4.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2.48,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":3.65,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":5.62,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":4.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":3.94,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":2.62,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":2.76,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2.33,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":4.72,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7.43,"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":7.02,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":5.78,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":3.30,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":6.20,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":7.43,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":6.61,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":3.72,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":1.79,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1.49,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":5.37,"methodology":"percent of total billed charges"}]}]},{"description":"DIGESTIVE MALIGNANCY WITH MCC ","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"DIL EX TRACT ENDUR NW AC ","code_information":[{"code":"788777","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":9658.64,"discounted_cash":9658.64,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":5206.01,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":2897.59,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":4269.12,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":3573.70,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":6567.88,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":3573.70,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":5795.18,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":4607.17,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":3061.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":3225.99,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":2723.74,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":5524.74,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8692.78,"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":8209.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":6761.05,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":3863.46,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":7243.98,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":8692.78,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":7726.91,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":4346.39,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":2095.92,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":1738.56,"methodology":"percent of total billed charges"}]}]},{"description":"DILTIAZEM 90MG TAB ","code_information":[{"code":"908435","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"DIMENHYDRINAT 15MGER CAP ","code_information":[{"code":"949296","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":17.68,"discounted_cash":17.68,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":9.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":7.81,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.02,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":10.61,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":8.43,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":5.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":5.91,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":4.99,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.11,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"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":15.03,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":12.38,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.07,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":13.26,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":15.91,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":14.14,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":7.96,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":3.84,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.18,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":11.49,"methodology":"percent of total billed charges"}]}]},{"description":"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT C ","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"DOFETILIDE 250MCG CAP ","code_information":[{"code":"920707","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":26.37,"discounted_cash":26.37,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":14.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":7.91,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":11.66,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":17.93,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":15.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":12.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":8.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":8.81,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":7.44,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":15.08,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":23.73,"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":22.41,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":18.46,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":10.55,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":19.78,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":23.73,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":21.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":11.87,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":5.72,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":4.75,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":17.14,"methodology":"percent of total billed charges"}]}]},{"description":"DRESSING NADH 4X3IN ","code_information":[{"code":"933075","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":1.00,"discounted_cash":1.00,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":0.54,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":0.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":0.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":0.68,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":0.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":0.48,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":0.32,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":0.33,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":0.28,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":0.57,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":0.90,"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":0.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":0.70,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":0.40,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":0.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":0.90,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":0.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":0.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":0.22,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":0.18,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":0.65,"methodology":"percent of total billed charges"}]}]},{"description":"DRONEDARONE 400MG PO ","code_information":[{"code":"951591","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":43.60,"discounted_cash":43.60,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":23.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":13.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":19.27,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":29.65,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":26.16,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":20.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":13.82,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":14.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":12.30,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":24.94,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":39.24,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":37.06,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":30.52,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":17.44,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":32.70,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":39.24,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":34.88,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":19.62,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":9.46,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":7.85,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":28.34,"methodology":"percent of total billed charges"}]}]},{"description":"DRSG SLVRLN 6X4 ILND ","code_information":[{"code":"843196","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":178.20,"discounted_cash":178.20,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":96.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":53.46,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":78.76,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":121.18,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":106.92,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":85.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":56.49,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":59.52,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":50.25,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":101.93,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":160.38,"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":151.47,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":124.74,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":71.28,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":133.65,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":160.38,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":142.56,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":80.19,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":38.67,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":32.08,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":115.83,"methodology":"percent of total billed charges"}]}]},{"description":"DULOXETINE 30MG CAP ","code_information":[{"code":"927663","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38.15,"discounted_cash":38.15,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":20.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":16.86,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":25.94,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":22.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":18.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":12.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":12.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":10.76,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":21.82,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34.34,"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":32.43,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":26.70,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":15.26,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":28.61,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34.34,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":30.52,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":8.28,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.87,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":24.80,"methodology":"percent of total billed charges"}]}]},{"description":"DUP LE ART UNI/LTD ","code_information":[{"code":"93926","type":"CPT"},{"code":"944831","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":584.66,"discounted_cash":584.66,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":315.13,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":175.40,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":258.42,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":216.32,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":397.57,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":216.32,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":350.80,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":278.88,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":185.34,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":195.28,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":164.87,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":334.43,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":526.19,"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":496.96,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":409.26,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":233.86,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":526.19,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":467.73,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":263.10,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":126.87,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":105.24,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":380.03,"methodology":"percent of total billed charges"}]}]},{"description":"DUP VEIN BIL ","code_information":[{"code":"93970","type":"CPT"},{"code":"955416","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":2994.76,"discounted_cash":2994.76,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":1614.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":898.43,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":1323.68,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1108.06,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":2036.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":1108.06,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":1796.86,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":1428.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":949.34,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":1000.25,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":844.52,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":1713.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2695.28,"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":2545.55,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":2096.33,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":1197.90,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":2695.28,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":2395.81,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":1347.64,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":649.86,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":539.06,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1946.59,"methodology":"percent of total billed charges"}]}]},{"description":"ECHO COLOR FLOW MAPPING ","code_information":[{"code":"901444","type":"CDM"},{"code":"93325","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":1503.34,"discounted_cash":1503.34,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":810.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":451.00,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":664.48,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":556.24,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1022.27,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":556.24,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":902.00,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":717.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":476.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":502.12,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":423.94,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":859.91,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1353.01,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOCOMPLEMENTARYNETWORK","standard_charge_percentage":85.00,"standard_charge_algorithm":"Reimbursement will be 85% of billable gross charges.","estimated_amount":1277.84,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1052.34,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":601.34,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":1127.51,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1353.01,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1202.67,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":676.50,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":326.22,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":270.60,"methodology":"percent of total billed charges"}]}]},{"description":"EEG REC AW & DROWSY ","code_information":[{"code":"901397","type":"CDM"},{"code":"95816","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":1626.28,"discounted_cash":1626.28,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":876.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":487.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":718.82,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":601.72,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":1105.87,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":601.72,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":975.77,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":775.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":515.53,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":543.18,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":458.61,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":930.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1463.65,"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":1382.34,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":1138.40,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":650.51,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":1463.65,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":1301.02,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":731.83,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":352.90,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":292.73,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":1057.08,"methodology":"percent of total billed charges"}]}]},{"description":"EEG WO VID 2-12 HR UNMON ","code_information":[{"code":"779044","type":"CDM"},{"code":"95705","type":"CPT"}],"standard_charges":[{"setting":"outpatient","gross_charge":759.21,"discounted_cash":759.21,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":409.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":227.76,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":335.57,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":280.91,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":516.26,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":280.91,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":455.53,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":362.14,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":240.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":253.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":214.10,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":434.27,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":683.29,"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":645.33,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":531.45,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":303.68,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":683.29,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":607.37,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":341.64,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":164.75,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":136.66,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":493.49,"methodology":"percent of total billed charges"}]}]},{"description":"EMTRICITABIN/TENEFOV TAB ","code_information":[{"code":"944855","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":130.75,"discounted_cash":130.75,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":70.47,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":39.23,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":57.79,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":88.91,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":78.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":62.37,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":41.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":43.67,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":36.87,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":74.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":117.67,"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":111.14,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":91.53,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":52.30,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":98.06,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":117.67,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":104.60,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":58.84,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":28.37,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":23.54,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":84.99,"methodology":"percent of total billed charges"}]}]},{"description":"ENDOCRINE DISORDERS WITH CC ","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":950.00,"maximum":8235.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar":1450.00,"methodology":"per diem"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","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":"United","plan_name":"AllPayerAppendix","standard_charge_dollar":8235.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $7635 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"ColoradoDoctorsPlan","standard_charge_dollar":6905.00,"methodology":"case rate","additional_payer_notes":"Days 1 - 2.  If billable gross charges exceed threshold of $558155.00, reimbursement will be $6390 per diem instead of the contracted rate."},{"payer_name":"United","plan_name":"GlobalBenefit","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":"OptionsPPO","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":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_dollar":950.00,"methodology":"per diem"}]}]},{"description":"ENDOMYSIAL FA AB QL ","code_information":[{"code":"86231","type":"CPT"},{"code":"902996","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":615.02,"discounted_cash":615.02,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":331.50,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":271.84,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":227.56,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":418.21,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":227.56,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":369.01,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":293.36,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":194.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":205.42,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":173.44,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":351.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":553.52,"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":522.77,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":430.51,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":246.01,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":553.52,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":276.76,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":133.46,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":110.70,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":399.76,"methodology":"percent of total billed charges"}]}]},{"description":"EPHEDRINE SUL 50MG INJ ","code_information":[{"code":"906992","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":155.05,"discounted_cash":155.05,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":83.57,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":46.52,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":68.53,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":105.43,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":93.03,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":73.96,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":49.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":51.79,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":43.72,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":88.69,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":139.55,"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":131.79,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":108.53,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":62.02,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":116.29,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":139.55,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":124.04,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":69.77,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":33.65,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":27.91,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":100.78,"methodology":"percent of total billed charges"}]}]},{"description":"EPINEPHRINE 0.1 MG INJ ","drug_information":{"unit":"0.1","type":"ME"},"code_information":[{"code":"953136","type":"CDM"},{"code":"J0171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":146.92,"discounted_cash":146.92,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":79.19,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":44.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":64.94,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":54.36,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":99.91,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":54.36,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":88.15,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":70.08,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":46.57,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":49.07,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":41.43,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":84.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":132.23,"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":124.88,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":102.84,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":58.77,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":110.19,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":132.23,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":117.54,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":66.11,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":31.88,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":26.45,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":95.50,"methodology":"percent of total billed charges"}]}]},{"description":"ESTROG CONJ\\1.25MG ","code_information":[{"code":"908963","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":19.09,"discounted_cash":19.09,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":10.29,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":5.73,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":8.44,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":12.98,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":9.11,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":6.05,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":6.38,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":5.38,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":10.92,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"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":16.23,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":13.36,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":7.64,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":14.32,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":17.18,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":15.27,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":8.59,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":4.14,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":3.44,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":12.41,"methodology":"percent of total billed charges"}]}]},{"description":"ESZOPICLONE 2MG TAB ","code_information":[{"code":"948978","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":38.15,"discounted_cash":38.15,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":20.56,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":11.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":16.86,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":25.94,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":22.89,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":18.20,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":12.09,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":12.74,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":10.76,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":21.82,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34.34,"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":32.43,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":26.70,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":15.26,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":28.61,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":34.34,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":30.52,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":17.17,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":8.28,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":6.87,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":24.80,"methodology":"percent of total billed charges"}]}]},{"description":"ETOPOSIDE 50 MG PO ","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"906644","type":"CDM"},{"code":"J8560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","gross_charge":234.16,"discounted_cash":234.16,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":126.21,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":70.25,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":103.50,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":86.64,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":159.23,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":86.64,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":140.50,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":111.69,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":74.23,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":78.21,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":66.03,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":133.94,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":210.74,"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":199.04,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":163.91,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":93.66,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":210.74,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":187.33,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":105.37,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":50.81,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":42.15,"methodology":"percent of total billed charges"},{"payer_name":"Western Plains Community Health","plan_name":"COMM","standard_charge_percentage":65.00,"standard_charge_algorithm":"Reimbursement will be 65% of billable gross charges.","estimated_amount":152.20,"methodology":"percent of total billed charges"}]}]},{"description":"EXCHANGE BILIARY CATH ","code_information":[{"code":"886477","type":"CDM"}],"standard_charges":[{"setting":"outpatient","gross_charge":11781.00,"discounted_cash":11781.00,"payers_information":[{"payer_name":"Aetna","plan_name":"ExistingBusiness","standard_charge_percentage":53.90,"standard_charge_algorithm":"Reimbursement will be 53.9% of billable gross charges.","estimated_amount":6349.96,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"MCRADVPPO","standard_charge_percentage":30.00,"standard_charge_algorithm":"Reimbursement will be 30% of billable gross charges.","estimated_amount":3534.30,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"NewBusiness","standard_charge_percentage":44.20,"standard_charge_algorithm":"Reimbursement will be 44.2% of billable gross charges.","estimated_amount":5207.20,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"HMO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":4358.97,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":8011.08,"methodology":"percent of total billed charges"},{"payer_name":"Anthem","plan_name":"PPO","standard_charge_percentage":37.00,"standard_charge_algorithm":"Reimbursement will be 37% of billable gross charges.","estimated_amount":4358.97,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_percentage":60.00,"standard_charge_algorithm":"Reimbursement will be 60% of billable gross charges.","estimated_amount":7068.60,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Broad","standard_charge_percentage":47.70,"standard_charge_algorithm":"Reimbursement will be 47.7% of billable gross charges.","estimated_amount":5619.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-NSBP","standard_charge_percentage":31.70,"standard_charge_algorithm":"Reimbursement will be 31.7% of billable gross charges.","estimated_amount":3734.58,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"Connect-SBP","standard_charge_percentage":33.40,"standard_charge_algorithm":"Reimbursement will be 33.4% of billable gross charges.","estimated_amount":3934.85,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"SureFit","standard_charge_percentage":28.20,"standard_charge_algorithm":"Reimbursement will be 28.2% of billable gross charges.","estimated_amount":3322.24,"methodology":"percent of total billed charges"},{"payer_name":"Kaiser","plan_name":"CommercialHMO","standard_charge_percentage":57.20,"standard_charge_algorithm":"Reimbursement will be 57.2% of billable gross charges.","estimated_amount":6738.73,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":10602.90,"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":10013.85,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"COMMPPOPRIMARYNETWORK","standard_charge_percentage":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":8246.70,"methodology":"percent of total billed charges"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":4712.40,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_percentage":75.00,"standard_charge_algorithm":"Reimbursement will be 75% of billable gross charges.","estimated_amount":8835.75,"methodology":"percent of total billed charges"},{"payer_name":"Prime Health","plan_name":"WORKERSCOMP","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":10602.90,"methodology":"percent of total billed charges"},{"payer_name":"TriWest Health Alliance","plan_name":"FED","standard_charge_percentage":80.00,"standard_charge_algorithm":"Reimbursement will be 80% of billable gross charges.","estimated_amount":9424.80,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"GlobalBenefit","standard_charge_percentage":45.00,"standard_charge_algorithm":"Reimbursement will be 45% of billable gross charges.","estimated_amount":5301.45,"methodology":"percent of total billed charges"},{"payer_name":"United","plan_name":"OptionsPPO","standard_charge_percentage":21.70,"standard_charge_algorithm":"Reimbursement will be 21.7% of billable gross charges.","estimated_amount":2556.48,"methodology":"percent of total billed charges"},{"payer_name":"Vail Clinic, Inc.","plan_name":"COMM","standard_charge_percentage":18.00,"standard_charge_algorithm":"Reimbursement will be 18% of billable gross charges.","estimated_amount":2120.58,"methodology":"percent of total billed charges"}]}]},{"description":"EXTRACRANIAL PROCEDURES WITH CC ","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","minimum":1150.00,"maximum":24974.00,"payers_information":[{"payer_name":"Anthem","plan_name":"PAR","standard_charge_percentage":68.00,"standard_charge_algorithm":"Reimbursement will be 68% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Averde Health","plan_name":"COMM","standard_charge_dollar":1200.00,"methodology":"per diem"},{"payer_name":"Multiplan","plan_name":"BeechStreetCOMMPPO","standard_charge_percentage":90.00,"standard_charge_algorithm":"Reimbursement will be 90% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"BeechStreetWorkersComp","standard_charge_dollar":1435.50,"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":70.00,"standard_charge_algorithm":"Reimbursement will be 70% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Multiplan","plan_name":"WorkersComp","standard_charge_dollar":1435.50,"methodology":"fee schedule"},{"payer_name":"Parkview Medical Self Funded Plan","plan_name":"COMM","standard_charge_percentage":40.00,"standard_charge_algorithm":"Reimbursement will be 40% of billable gross charges.","estimated_amount":999999999.00,"methodology":"percent of total billed charges"},{"payer_name":"Pinnacol Workers Comp","plan_name":"WORKERSCOMP","standard_charge_dollar